Payor Authorization Operations Manager

Payor Authorization Operations Manager

We're looking for a passionate and detail-oriented expert to join us as a Payor 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 carenavigating 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.

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.

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.

Benefits :

Competitive compensation packages that reflect the value you bring. We reward our team for the impact of their work. This is Full-Time role with an estimated $70,000 - $77,000 base salary + annual bonus + benefits

Comprehensive health coverage that works for you. We cover 90% of your premiums and 70% for your dependents, with multiple PPO plan options to choose from for medical, vision, dental, life, and short-term disability.

Generous paid time off. We provide policies that allow you to recharge along with 10 paid company holidays.

Team bonding. We love bringing our teams together. As a full-time employee, you'll get to connect, collaborate, and have fun through team activities and our annual company retreat.

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.