Payor Authorization Operations Manager

About Abby Care: Powering the future of care at home for all of America. Abby Care is building the leading AI-native platform for family-led care. America is facing a growing care crisis. Millions more people need care at home than ever. Over 50 million family caregivers support loved ones without the tools, training, or recognition they deserve. We believe families are the largest untapped caregiving workforce in America, and that technology can help them deliver better care while driving stronger outcomes and greater transparency across the healthcare system. Abby Care combines clinical oversight with an AI-powered platform to train, enable, and support family caregivers in delivering high-quality care at home. Our platform helps health plans and government partners better understand, verify, and improve care in the home. We expand access to care, reduce reliance on higher-cost settings, and help ensure public dollars are spent effectively. We are proud to partner with leading health plans, providers, and community organizations and are backed by top VCs. We envision a future where family-led care is a core part of the healthcare system. Abby Care is building that future. Join us in solving one of the most important challenges of our time. The Role We're looking for a passionate and detail-oriented expert to join us as a Payer Authorization Operations Manager . This is a Full-Time Remote opportunity based in Denver, Colorado . You are a strategic authorization operator who turns complex Colorado LTSS and LTHH requirements into seamless patient care, navigating Colorado Medicaid systems and building trust with case managers, internal stakeholders, and HCPF to ensure uninterrupted services for vulnerable populations. Key Responsibilities:  Master Colorado's LTHH landscape. Lead authorization operations for Colorado's HCBS waiver programs (CHCBS, EBD, SLS, CES, CFC) and Long Term Home Health services, ensuring 100% compliance with HCPF policies and ColoradoPAR system requirements. Oversee end-to-end prior authorization. Own prior authorization process while leading and managing the team of Doc Collectors and Re-Authorization Associates, maintaining current knowledge of payer requirements and ensuring adherence to all guidelines and timelines. Manage Reauthorizations. Build out the process and manage the team handling all reauthorization submissions for Colorado's waiver programs (CHCBS, EBD, SLS, CES, CFC) and Long Term Home Health services to ensure patients have no lapse in care. Internal Coordination. In cases where appeals are needed, act as an expert to help families navigate the appeals process as and when appropriate. Coordinate with our internal teams to troubleshoot and resolve any issues around authorizations impacting the revenue lifecycle. Lead complex case resolution. Serve as the escalation point for disputed Colorado Medicaid authorizations, appeals, and emergency requests, working directly with HCPF and Acentra (Kepro) to advocate for timely patient care approvals. Navigate dual eligibility complexities. Build expertise in Medicaid coordination for Colorado beneficiaries; manage intricate authorization scenarios involving and ensure seamless care transitions. Drive team excellence. Create and execute training programs on Colorado-specific prior authorization requirements, mentor staff on LTHH waiver nuances, and establish performance metrics that drive strong approval rates and sub-10-day processing times. The Requirements: 5+ years Colorado Medicaid authorization experience (LTHH, LTSS or waiver programs) with a proven track record of managing complex authorization portfolios and achieving high approval rates. Bachelor's degree in Healthcare Administration, Business, or equivalent is preferred. Colorado Medicaid certification and LTHH authorization training strongly preferred. Existing deep knowledge of Colorado's LTHH ecosystem including HCPF policies, prior auth operations, case coordination, and ColoradoPAR system; can demonstrate successful navigation of Colorado waiver program transitions and appeals. Expert relationship builder with strong communication, problem-solving, and stakeholder management skills; proven ability to work effectively with state agencies, payer entities, and provider networks. High-agency operator who executes cross-functional work in ambiguous regulatory environments; process-driven and metrics-focused with experience in CRM systems, data analysis, and Colorado-specific compliance requirements. Benefits: Competitive compensation packages that reflect the value you bring. We reward our team for the impact of their work – full-time employees are eligible for an annual company performance bonus. Comprehensive health coverage that works for you. Choose from high-quality medical dental and vision options, including a $0 deductible PPO and a company-funded HSA, alongside employer-paid life and disability insurance. Generous paid time off. We provide policies that allow you to recharge along with 10 paid company holidays. Financial savings benefits to support your future. We support your financial well-being with HSA contributions, optional FSA and commuter benefits, and full coverage of all 401(k) account fees (employer match not currently offered). Paid parental leave to support your growing family. We provide paid leave, so you can focus on bonding and adjusting to life as your family grows. We are an equal opportunity employer and welcome applicants from all backgrounds, consistent with applicable laws. Employment is contingent upon successful completion of a background check, satisfactory references, and any required documentation. Our Values Families First Redefining healthcare starts with how we treat the parents and children we serve. We go above and beyond for every family, building strong, lasting relationships. We continually ask ourselves, “Would we want this for our own families?” Urgency with Precision Millions of families are waiting for care, and they cannot wait, therefore this is not your typical 9 to 5 job. We match their urgency with our own, delivering exceptional care without compromise. Here, speed and excellence go hand in hand . Relentlessly Resourceful As an ambitious startup, we adapt quickly and make the most of limited time and resources. We solve challenges with creativity to deliver results without unnecessary complexity. Purpose with Positivity We take our mission seriously while never losing sight of the people behind the work. Respect, kindness, memes, and coffee make us stronger as a team and better for the families we serve. Driven to Redefine What’s Possible We are here to make healthcare better, which means asking hard questions, challenging outdated systems, and finding smarter, more compassionate ways to deliver care.

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