Abby Care

General

• Serve as the primary point of contact for caregivers and families via phone, text, and email.
• Guide caregivers through the onboarding process, training milestones, required documentation, and program requirements.
• Manage an active caseload of caregivers, ensuring timely completion of onboarding tasks and successful transition into active care.
• Provide ongoing support to enrolled families by answering questions, resolving concerns, and coordinating requests with internal teams.
• Coordinate care logistics, including scheduling Start of Care (SOC) visits, training sessions, and other caregiver appointments.
• Maintain accurate documentation and caregiver records across internal systems.
• Monitor caregiver progress, proactively follow up on outstanding requirements, and remove barriers that may delay onboarding or care delivery.
• Communicate caregiver feedback and family concerns with clinical, operations, and support teams to ensure timely resolution.
• Handle a high volume of daily communication through calls, text messages, and email while maintaining exceptional service quality.
• Educate caregivers and families on program processes, expectations, and available resources in a clear and supportive manner.
• Help improve caregiver engagement by providing encouragement, coaching, and proactive follow-up throughout their journey.
• Collaborate cross-functionally to improve operational workflows and enhance the caregiver experience.

Family Care & Empowerment Associate

• Serve as the primary point of contact for parents via phone, text, and email
• Provide timely, empathetic, and professional responses to parent inquiries and concerns
• Handle inbound calls and follow-ups (approximately 180 calls per month)
• Coordinate and communicate parent requests, feedback, and updates with the internal care team
• Maintain accurate documentation of interactions and updates in internal systems
• Ensure parents receive clear information and support throughout their experience
• Manage multiple conversations and tasks simultaneously while maintaining a high level of service

Family Care Associate

Operations

• 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.

Payor Authorization Operations Manager

• Own the full sales cycle from initial outreach through provider commitment.
• Engage physicians, administrators and clinical decision makers to drive adoption.
• Navigate clinical objections, compliance considerations and operational workflows.
• Convert qualified leads into signed participation.
• Maintain a clean, accurate pipeline in Salesforce.
• Prioritize high-intent providers for progress and nurturing.
• Forecast accurately and consistently against quota.
• Partner with internal teams for smooth activation and onboarding.
• Focus on providers and execute targeted outbound strategies within assigned territories.

Founding Territory Representative

General Counsel

• Own Abby Care's privacy program — HIPAA compliance, state privacy law compliance, BAA program, data mapping and ROPA, privacy incident response, breach assessment and notification, and individual rights workflows — including its design, operation, measurement, and continuous improvement.
• Own Abby Care's AI governance program — the responsible AI policy suite, AI inventory, AI use case intake and review process, model risk classification, ongoing monitoring, and AI incident response — and evolve it as the regulatory and deployment landscape shifts.
• Lead AI use case reviews for internal generative and agentic AI tools and for AI-powered features in Abby Care's product, including chart update, documentation extraction, and clinical decision support. Set the SLAs and the review framework; escalate the hard cases to the GC.
• Set regulatory change management strategy across federal and state privacy and AI law. Translate horizon scanning into program and product decisions, not just memos.
• Own the BAA program end-to-end, including standard templates, fallback positions, vendor risk integration, and downstream subcontractor flow-downs.
• Serve as the senior legal partner to Product, Engineering, Operations and Clinical teams on the privacy and AI implications of new and existing features. Review PRDs, design documents, and model cards; sit in design reviews; influence the roadmap.
• Lead privacy and AI incident response, including investigation, breach analysis, regulator and individual notification, and post-incident program remediation.
• Prepare the privacy and AI sections of the Board package, with the General Counsel.
• Manage outside privacy and AI counsel relationships, including scope, budget, and quality of work product.
• Hire, develop, and lead the privacy and AI team as it grows.
• Partner with the General Counsel and Compliance leadership on Privacy Officer designation, training and awareness programs, and the integration of privacy and AI controls into the broader compliance program.

Senior Privacy and AI Counsel

• Guide families through onboarding, training, and care-related processes.
• Serve as a primary point of contact for families via phone, email, and text.
• Provide compassionate support and clear communication throughout the family journey.
• Follow up with families to ensure timely completion of required tasks and milestones.
• Collect, review, and track required documentation from families and caregivers.
• Ensure documentation is accurate, complete, and compliant with applicable healthcare and regulatory requirements.
• Monitor document expirations and proactively coordinate renewals and updates.
• Maintain organized records and documentation tracking systems.
• Coordinate with operations, clinical, onboarding, and support teams to facilitate family admissions and ongoing care processes.
• Track progress across multiple workflows and ensure timely completion of operational tasks.
• Help identify and resolve barriers that may delay onboarding, training, or service delivery.
• Contribute to process improvements that enhance the family experience and operational efficiency.
• Support initiatives that foster engagement and connection among families.
• Assist with coordinating educational sessions, events, and community-building activities.
• Help families access resources and navigate healthcare-related processes with confidence.

Care Operations Associate

Compliance

• Own licensure and survey readiness. Lead preparation, on-site execution, and response for state licensure surveys, audits, and inspections in your states — including drafting plans of correction and driving every finding to closure.
• Localize policies and procedures. Adapt and maintain operational policies and procedures for your states, capture state-specific regulatory variations, help develop the state-specific components of enterprise policies, and keep everything current as rules change.
• Track the regulatory landscape. Monitor state-level developments in your markets — Medicaid bulletins, agency guidance, licensure rule changes, payor policy updates — translate them into actionable operational changes, and feed them to compliance leadership for enterprise integration.
• Deliver training that sticks. Bring compliance training to your state operating teams, including onboarding, role-specific content, and refreshers tied to regulatory change, and help build the state-specific content behind it.
• Monitor and remediate. Execute state-level program monitoring, support enterprise audit activities in your markets, and make sure findings get fixed — with trends flowing back into updated policies and training.
• Be the partner operations counts on. Serve as the standing compliance partner to state operations leadership and the first call when a compliance issue arises in your states.
• Your scope covers every health care delivery program we operate in your states today — Medicaid home health, HCBS waiver programs, and family caregiver services — and will grow to absorb new programs as we do.

Regional Compliance Manager

Account Manager

• Ride-Alongs & Coaching: Spend 3 days per week in the field with your reps. Observe their pitches, correct their clinical messaging and model how to properly work and partner with Case Managers, PCPs, Therapists, etc.
• Pipeline Inspection: Run weekly 1:1s that are rigorous and deal-focused. You inspect every Lead in Salesforce to ensure it is qualified & advancing.
• Onboarding Acceleration: You own the "Time to Ramp" for new hires in your market. You ensure they are certified on the pitch and productive within their first 30 days.
• Block & Tackle: You remove obstacles for your team. Whether it’s a stuck Lead, a difficult operational issue or a marketing need. You clear the path so they can sell.
• Exceeding Targets: Ensuring the team are not only meeting but exceeding company level expectations.

Territory Manager, Partnerships

• Lead the establishment of revenue cycle operations for a newly launched market, including researching payer requirements, workflows, billing processes, and reimbursement guidelines.
• Develop, document, and implement SOPs, workflows, and operational best practices to support future team growth.
• Research and interpret Georgia and New Jersey Medicaid billing requirements and identify operational requirements necessary to support compliance and reimbursement.
• Partner with leadership to define team structure, operational processes, performance metrics, and future KPIs as the department scales.
• Identify process gaps and recommend solutions to improve operational efficiency and future revenue cycle performance.
• Initially operate as an individual contributor while building the foundation of the department.
• Transition into a people leadership role as the Georgia and New Jersey markets expand, including hiring, training, coaching, and managing billing team members.
• Provide mentorship, onboarding support, and performance coaching to future team members.
• Oversee the preparation, submission, and follow-up of insurance claims for home health care services.
• Ensure accurate coding (CPT, HCPCS, ICD-10) and adherence to payer-specific guidelines.
• Monitor and resolve claim rejections, denials, and underpayments promptly.
• Manage accounts receivable to minimize outstanding balances and maximize collections.
• Ensure billing practices comply with federal, state, and payer-specific regulations, including Medicare and Medicaid guidelines.
• Maintain up-to-date knowledge of changes in billing rules and home health care regulations.
• Review documentation for accuracy and completeness to support submitted claims.
• Analyze billing processes and implement strategies to improve efficiency and reduce errors.
• Collaborate with other departments to address issues impacting the revenue cycle, such as intake and documentation workflows.

Revenue Cycle Management Operations Lead

Manager

• Manage a diverse caseload with quality care and efficient coordination.
• Develop and implement individualized care plans based on assessments and goals.
• Coordinate with PCPs and internal teams for comprehensive care.
• Coach and oversee HHAs to ensure adherence to clinical standards.
• Educate patients and families on health needs and treatment plans.
• Maintain accurate and timely electronic charting, with a preference for real-time documentation.
• Ensure all documentation meets regulatory and Abby Care standards, with a minimum of 24-hour turnaround time.
• Complete administrative tasks (e.g., mileage reimbursements) thoroughly.
• Design and implement skill training classes for HHA students.
• Support students during in-person training at long-term care facilities.
• Collaborate with clinical team to develop additional learning modules.
• Enhance students' clinical skills and medical knowledge through creative curriculum.
• Build effective relationships with PCPs and internal teams.
• Escalate issues to Clinical Leads appropriately and promptly.
• Participate in on-call rotation (~1 weekend/month) and holiday coverage.
• Monitor and improve patient readmission rates and caregiver satisfaction.

RN Case Manager – Clinical Instructor

Product Manager

• Own end-to-end product execution: Take full ownership of complex, operationally critical product areas, from problem discovery and PRDs through delivery, launch, and iteration. Be accountable for real-world outcomes across care delivery, clinical, and operations.
• Translate real-world care workflows into product: Partner with caregivers, clinicians, operations, and compliance teams to understand how care is delivered today and turn those workflows into intuitive, reliable, and scalable product experiences.
• Build AI-assisted care delivery systems: Lead the design and iteration of AI-powered workflows, including automation, intelligent defaults, decision support, and human-in-the-loop systems that meaningfully improve care quality, operational efficiency, and caregiver experience.
• Innovate alongside the broader care ecosystem: Collaborate with providers, payors, regulators, and internal clinical leaders to unlock new models of care delivery and shape product strategy in regulated environments.
• Raise the bar for product thinking and execution: Set a high standard for product clarity, judgment, and craft. Inspire cross-functional collaboration, and continuously elevate how product decisions are made and shipped across EPD.

Senior Product Manager, AI-Native Care

• Manage a diverse caseload, ensuring quality patient care and efficient care coordination.
• Provide coaching, oversight, and support to Certified Nursing Assistants (CNAs) to ensure high-quality patient care and adherence to clinical standards.
• Develop and implement individualized care plans based on patient assessments and goals.
• Coordinate with PCPs, therapy providers, and internal support teams to ensure comprehensive care.
• Provide education and support to patients and families regarding their health care needs and treatment plans.
• Maintain accurate and timely electronic charting, with a preference for real-time documentation.
• Ensure all documentation meets regulatory and Abby Care standards, with a minimum of 24-hour turnaround time.
• Establish and maintain effective communication with PCPs, therapy providers, and internal support teams.
• Escalate appropriate issues to Clinical Leads in a timely manner, such as order management and patient concerns.
• Participate in on-call rotation (approximately one weekend per month), holiday rotation, and possible phone triage night coverage during weekdays.
• Achieve caregiver satisfaction by providing high-quality, compassionate care and support.
• Monitor and work to improve patient readmission rates.
• Ensure extended visits remain within acceptable ranges and administrative tasks (e.g., mileage reimbursements) are completed thoroughly.

RN Case Manager

• Design, build, deploy, and continuously improve a comprehensive enterprise compliance program covering every aspect of Abby Care's healthcare operations, anchored to the OIG seven-element framework and the DOJ's Evaluation of Corporate Compliance Programs guidance.
• Set the company's compliance strategy and priorities, including the annual enterprise risk assessment, multi-year work plan, audit and monitoring calendar, and annual program effectiveness review; secure the resourcing and Board endorsement to execute against them.
• Establish and operate the program's full operational backbone — policies and procedures, training and culture, reporting and hotline channels, monitoring and auditing, investigations, discipline, and corrective action — and ensure each element is functioning, measurable, and improving.
• Lead compliance across the full program lifecycle, clinical operations, documentation, billing and coding, EVV, payor and MCO contract performance, and program integrity; and work to build a culture of compliance by embedding compliance into how the business runs rather than bolting it on.
• Lead regulatory change management across the federal stack (AKS, Stark, FCA, HIPAA/HITECH, CMS, OIG, HRSA, and the 21st Century Cures Act) and across each state Medicaid environment in which we operate.
• Manage all government inquiries, audits, investigations, self-disclosures, and any settlement or CIA obligations; serve as the company's principal compliance liaison to regulators, MCO program integrity functions, and external counsel.
• Partner with Legal, People, Operations, Clinical Leadership, Information Security, and Finance to embed compliance controls across the workforce, software and vendor ecosystem, and care delivery model.
• Partner with the General Counsel on compliance initiatives regarding AI governance and the deployment of AI in clinical and operational workflows, including FDA SaMD/CDS analysis, documentation integrity, and patient-facing disclosures.
• Lead compliance diligence and integration for new market entry, new Medicaid program design, new service lines, and M&A activity.
• Serve as the company's designated Compliance Officer; chair the Compliance Committee; report regularly to the Board on risk posture, incidents and program effectiveness, with independent access as needed.
• Build, hire, and develop a high-performing in-house compliance team, investigations, auditing and monitoring, training, and compliance operations and analytics, and the technology infrastructure that supports a modern program.

VP, Compliance

Growth Marketing

• Lead Regional Growth Teams: Oversee multiple teams, driving efficiency and process improvements to enhance patient experience.
• Drive Partnerships & Referrals: Guide Business Development Associates in expanding partnerships, creating brand awareness, and optimizing resource allocation for growth.
• Optimize Intake Operations: Streamline the intake process to ensure efficient lead management, accurate data collection, and timely qualification.
• Manage Document Collection: Oversee teams handling documentation review to qualify families for our program.
• Leverage Data & Analytics: Use data-driven insights to refine strategies, optimize processes, and drive growth.
• Ensure Cross-Functional Alignment: Collaborate with the General Manager and other departments to align growth strategies with state objectives.
• Champion Operational Excellence: Establish workflows and maintain consistent execution across growth teams.

Family Care & Empowerment Associate

Family Care Associate

Payor Authorization Operations Manager

Founding Territory Representative

Senior Privacy and AI Counsel

Care Operations Associate

Regional Compliance Manager

Territory Manager, Partnerships

Revenue Cycle Management Operations Lead

RN Case Manager – Clinical Instructor

Senior Product Manager, AI-Native Care

RN Case Manager

VP, Compliance

Strategy & Growth Manager

RN Case Manager