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 Opportunity:

Were looking for a passionate and detail-oriented leader to join us as a Payor Authorization Operations Manager. In this role you will oversee our end-to-end prior authorization and reauthorization processes managing a dedicated team to ensure 100% compliance and zero lapses in patient care. Reporting to the Care Operations Manager you will take ownership of our operational pipeline collaborate cross-functionally to optimize the revenue lifecycle and serve as the ultimate champion for our families navigating complex state systems.

A strategic authorization operator you turn complex Massachusetts LTSS and LTHH requirements into seamless patient care. You are equally comfortable navigating regional Medicaid systems and building deep trust with case managers internal stakeholders and state agencies to advocate for vulnerable populations. High-agency and process-driven you have a passion for mentoring staff analyzing operational metrics and executing cross-functional work within ambiguous regulatory environments.

This is a Full-Time hybrid opportunity based in Braintree MA (Boston).

What youll work on:

• Master the LTHH landscape: Lead authorization operations for Massachusetts HCBS waiver programs (CHCBS EBD SLS CES CFC) and Long Term Home Health services ensuring 100% compliance with HCPF policies and PAR system requirements.

• Oversee end-to-end prior authorization: Own the prior authorization process while leading and managing a team of Doc Collectors and Re-Authorization Associates maintaining current knowledge of payer requirements.

• Manage reauthorizations: Build out processes and manage the team handling all reauthorization submissions for regional waiver programs and Long Term Home Health services to ensure patients have no lapse in care.

• Coordinate internal lifecycles: Partner with internal teams to troubleshoot and resolve authorization issues impacting the revenue lifecycle and serve as an expert helping families navigate the appeals process.

• Lead complex case resolution: Serve as the primary escalation point for disputed 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 beneficiaries and manage intricate authorization scenarios to ensure seamless care transitions.

• Drive team excellence: Create and execute training programs on 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.

What success looks like:

Success in this role means hitting the ground running as an action-oriented self-motivated leader who combines absolute operational grit with a deep hunger to optimize processes. You will serve as a master translator of complex healthcare information seamlessly synthesizing data from various areas into simple actionable workflows that ensure flawless documentation from initial caregiver touchpoints through to appeals hearings. By staying hyper-aligned with evolving state policies and collaborating cross-functionally you will make sound high-stakes decisions that protect both our revenue lifecycle and uninterrupted care for our families.

What youll have:

Required Qualifications:

• 5 years of Massachusetts Medicaid authorization experience (LTHH LTSS or waiver programs) with a proven track record of managing complex authorization portfolios and achieving high approval rates.

• Deep existing knowledge of the regional LTHH ecosystem including HCPF policies prior authorization operations case coordination and MAPAR systems.

• Expert relationship-building skills with strong communication problem-solving and stakeholder management capabilities across state agencies payer entities and provider networks.

• High-agency operations background with experience using CRM systems data analysis and driving metrics-focused compliance requirements.

• Must reside or be willing to permanently relocate to the Braintree MA (Boston) area.

Preferred Qualifications:

• Bachelors degree in Healthcare Administration Business or equivalent field.

• Massachusetts Medicaid certification and LTHH authorization training strongly preferred.

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

1. 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

2. 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.

3. 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.

4. 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.

5. Driven to Redefine Whats 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.

Automated Decision Tools

Abby Care may use automated decision tools to help match and rank candidate work experience education and skills found in online profiles resumes and job applications against job requirements. We believe that these tools help ensure objective data-based decisions during the hiring process however all Abby Care hiring decisions involve final human review and input. If you have questions or would like to request an alternative process contact .

Required Experience:

Manager