Overview
At Help at Home, we believe everyone deserves the opportunity to live safely and independently in their own home. Our teams support individuals from diverse backgrounds and communities, and we are committed to creating a workplace where employees feel respected, supported, and empowered to make a difference.
The Senior Manager, Authorization Management, Eligibility & Care Continuity provides enterprise leadership for authorization operations, eligibility management, and Care Continuity functions across Client Lifecycle Operations. This role is responsible for protecting continuity of care and revenue by ensuring existing clients maintain accurate eligibility, timely authorizations and reauthorizations, and coordinated resolution of payer-related barriers that could disrupt services.
This leader will oversee Care Continuity Managers and their teams while serving as a key business owner for authorization and eligibility transformation initiatives. The role combines operational leadership, technology enablement, process improvement, and cross-functional collaboration to create scalable, standardized workflows that improve the client experience and support organizational growth.
Our Benefits:
Comprehensive medical, dental, and vision coverage
401(k) retirement plan
Paid time off and holidays
Employee assistance programs and wellness initiatives
Flexible options to support a balanced life
Responsibilities
What You'll Do:
Lead Care Continuity Managers, Supervisors, and frontline teams responsible for existing-client authorization management, reauthorization, eligibility follow-up, payer changes, and continuity-of-service support.
Establish operating standards, service-level expectations, work queues, and escalation processes that drive timely completion, accurate documentation, and effective coordination across New Client Activation, Field Operations, Revenue Cycle, and payer partners.
Protect client continuity and revenue through proactive authorization monitoring, timely reauthorizations, eligibility verification, authorization accuracy controls, and rapid resolution of potential service disruptions.
Own the business strategy, implementation, stabilization, and expansion of Salesforce Authorization Management across current and future markets.
Lead integrations between Salesforce Authorization Management, VIV, and other source systems to improve data accuracy, reduce duplicate work, and strengthen downstream operations.
Direct the implementation of authorization email and AI-reader capabilities, including intelligent document ingestion, automated record creation, routing, exception handling, and quality controls.
Serve as the business owner for 270/271 eligibility capabilities , overseeing workflow design, vendor and technology partnerships, exception management, adoption, and performance reporting.
Lead Client Lifecycle Operations workstreams associated with BPO migration, including scope definition, knowledge transfer, workforce transition, readiness, quality, service-level expectations, and ongoing vendor governance.
Establish and monitor authorization, eligibility, and Care Continuity KPIs, including backlog, aging, turnaround time, accuracy, automation rate, denial risk, productivity, quality, and service disruptions avoided.
Partner cross-functionally with Product, Business Technology, Revenue Cycle, Compliance, Payer Strategy, Field Operations, Finance, Analytics, Training, and Change Management to translate business needs into scalable solutions.
Lead business requirements, process design, user acceptance testing, release readiness, training, adoption, hypercare, and continuous improvement initiatives.
Oversee BPO and vendor performance to ensure productivity, quality, compliance, financial return, and alignment with enterprise standards.
Build a culture of ownership, urgency, operational discipline, service excellence, and continuous improvement while developing leaders and strengthening succession capabilities.
Qualifications
What You'll Bring:
Proven ability to lead multi-layered teams, including Managers, Supervisors, frontline staff, and BPO partners across multiple markets.
Strong knowledge of authorization management, reauthorization, eligibility verification, payer requirements, revenue protection, and continuity-of-care operations.
Demonstrated success leading enterprise technology and process implementations from business requirements through deployment, adoption, stabilization, and optimization.
Advanced analytical skills with the ability to interpret operational, financial, quality, and risk data and turn insights into actionable plans.
Strong problem-solving and escalation-management skills with the ability to balance client needs, compliance requirements, revenue risk, and operational capacity.
Excellent verbal and written communication skills with the ability to influence cross-functional stakeholders and effectively present performance, risks, and recommendations to senior leadership.
Ability to manage multiple strategic initiatives and operational priorities simultaneously while maintaining accountability, governance, and follow-through.
Leadership approach that promotes ownership, urgency, service excellence, and continuous improvement.
S ecurity Responsibilities
All employees must follow Help at Home cybersecurity and privacy policies, protect sensitive data, complete required training, and report suspected incidents. They must also follow acceptable use and access requirements and use only authorized systems.
Education and Experience :
High school diploma or GED required; bachelor's degree in business , Healthcare Administration, Operations, or a related field preferred .
Minimum of eight (8) years of experience in healthcare operations, authorization management, eligibility, revenue cycle, client access, payer operations, or client services.
Previous management experience overseeing leaders and multi-layered operational teams required.
Experience within home care, Medicaid, Medicare, managed care, long-term services and supports (LTSS), or other payer-driven healthcare environments preferred .
Experience leading enterprise system implementations, workflow automation, BPO/vendor transitions, or authorization and eligibility technology initiatives preferred.
Ability to travel monthly or quarterly as business needs require.
Pay Range
USD $105,000.00 - USD $120,000.00 /Hr.
