Colorado Medicaid Authorization Manager

Job Summary

A company is looking for a Payor Authorization Operations Manager.

Key Responsibilities:

• Lead authorization operations for Colorado's HCBS waiver programs and Long Term Home Health services, ensuring compliance with policies and requirements
• Oversee the prior authorization process, managing a team and ensuring adherence to payer guidelines and timelines
• Serve as an escalation point for disputed authorizations and coordinate with internal teams to resolve issues affecting revenue

Required Qualifications:

• 5+ years of experience in Colorado Medicaid authorization with a track record of managing complex portfolios
• Bachelor's degree in Healthcare Administration, Business, or a related field is preferred
• Deep knowledge of Colorado's LTHH ecosystem, including HCPF policies and prior authorization operations
• Proven ability to build relationships and work effectively with state agencies and payer entities
• Experience in executing cross-functional work in regulatory environments and familiarity with CRM systems