Payor Authorization Operations Manager

Payor Authorization Operations Manager

We're looking for a passionate and detail-oriented expert to join us as a Payer Authorization Operations Manager. This is a Full-Time Hybrid opportunity based in Indianapolis, Indiana.

You are a strategic authorization operator who turns complex Medicaid Fee-For-Service, Medicaid Managed Care Organization, Medicaid Waivers, and Commercial Insurance requirements into seamless patient carenavigating Indiana's Medicaid systems and building trust with case managers, internal stakeholders, and MCOs to ensure uninterrupted services for vulnerable populations.

Key Responsibilities :

Master Indiana's Prior Authorization landscape. Lead prior authorization operations for Indiana's home health services through fee-for-service, Managed Care Entities, and commercial insurance, as well as IHCP waiver programs (ATTC, SFC, HCA), ensuring 100% compliance with IHCP policies and 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 Indiana's programs and services to ensure patients have no lapse in care.

Internal Coordination. In cases where appeals and administrative reviews are needed, act as an expert to help families navigate the 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 Indiana Medicaid authorizations, appeals, and emergency requests, working directly with IHCP, MCOs, and Commercial Payers to advocate for timely patient care approvals.

Navigate dual eligibility complexities. Build expertise in Medicaid coordination for Indiana beneficiaries; manage intricate authorization scenarios involving and ensure seamless care transitions.

The Requirements :

Our Values :

Benefits :

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.