Payor Authorization Operations Manager

Abby Care

Operations Manager overseeing payor authorization operations for a healthcare startup focused on family-led care. Ensuring compliance and collaborating internally for effective patient care.

Posted 6/25/2026full-timeBoston • Massachusetts • 🇺🇸 United StatesMid-LevelSeniorWebsite

ATS Keywords

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Hard Skills

Massachusetts Medicaid authorizationprior authorization operationscase coordinationdata analysisperformance metricsauthorization process managementreauthorization submissionscompliance requirementsLTHH waiver programsMAPAR systems

Soft Skills

relationship-buildingcommunicationproblem-solvingstakeholder managementmentoringteam leadershiptraining program developmenttroubleshootingadvocacyexpertise in complex case resolution

Tools & Technologies

CRM systemsHCPF policiesPAR systemAcentra (Kepro)data analysis toolsauthorization management systemsperformance tracking toolscompliance tracking systemsappeals process navigationrevenue lifecycle management

Industry Keywords

LTHH landscapeHCBS waiver programsEBDSLSCESCFCdual eligibilityMedicaid coordinationhigh approval ratesBraintree, MA

About the role

Key responsibilities & impact

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.

Requirements

What you’ll need

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.

Benefits

Comp & perks

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.