Payer Authorization Operations Associate

About the role

Abby Care is seeking a dedicated Payer Authorization Operations Associate to join its mission of empowering family-led care through technology and clinical oversight. In this role, you will own the end-to-end management of payer authorization documentation to ensure uninterrupted home care services for patients. You will act as a critical liaison between families, caregivers, and internal teams, navigating complex healthcare requirements with empathy and precision. The position demands a proactive mindset to prevent authorization lapses and maintain seamless care continuity in a fast-paced environment. You will leverage strong organizational skills to handle high-volume tasks while adapting to evolving payer regulations and internal processes. Success in this role means driving operational excellence and directly supporting vulnerable populations during some of their most challenging moments.

Key facts

What you'll do

Collect, review, validate, and track all documentation required for payer authorizations and re-authorizations to maintain active care status.

Prepare and submit complete authorization packets within strict timelines to prevent any interruption in patient care and avoid coverage gaps.

Ensure every submission aligns with Medicaid, Medicare, payer, and state-specific regulatory requirements without exception.

Maintain accurate, up-to-date documentation and records across multiple internal systems to support audits and operational reporting.

Serve as the primary point of contact for families and caregivers, managing approximately 50-70 inbound and outbound calls daily with professionalism.

Respond to authorization status inquiries, documentation questions, and benefit details via phone, email, and text with timely follow-up.

Monitor authorization timelines meticulously to identify upcoming expirations and proactively initiate renewal sequences.

Prioritize competing requests based on urgency and complexity while sustaining high accuracy and exceptional service levels.

Identify documentation issues at the earliest opportunity and coordinate with internal teams to resolve barriers efficiently.

Partner closely with Onboarding, Credentialing, Family Support, Clinical Operations, and other departments to ensure documentation completeness.

Escalate complex authorization issues to appropriate stakeholders while preserving clear communication and transparency.

Contribute to continuous process improvement initiatives aimed at increasing efficiency and reducing authorization cycle times.

Support quality assurance efforts by adhering to standardized procedures and implementing best practices in documentation management.

Assist in training and knowledge transfer activities to strengthen the overall capability of the authorization operations team.

Maintain detailed logs of all interactions and decisions to ensure full traceability and compliance with healthcare protocols.

Requirements

Candidates must possess 2+ years of experience in healthcare operations, healthcare administration, customer service, or administrative support roles.

You must have direct experience managing prior authorizations, payer documentation, or similar healthcare operations responsibilities.

Demonstrated success handling high-volume inbound and outbound calls in a fast-paced, deadline-driven environment is essential.

You must show a proven track record of managing documentation with exceptional accuracy and meticulous attention to detail.

Strong organizational skills are required to balance multiple priorities, meet strict deadlines, and maintain accurate records.

Excellent written and verbal communication skills are necessary to interact effectively with families, caregivers, and internal stakeholders.

The ability to adapt quickly to changing payer requirements, regulations, and internal processes is a mandatory capability.

A high school diploma or equivalent is required; additional education in healthcare or business is preferred but not mandatory.

You must be able to perform all duties remotely from the Philippines with reliable internet connectivity and a suitable workspace.

Legal right to work in the Philippines must be available without sponsorship requirements for this position.

Proficiency in standard office software and learning new systems quickly is expected for success in this role.

Willingness to follow established healthcare compliance guidelines and procedural documentation standards is required.

Candidates must demonstrate professionalism, discretion, and empathy when handling sensitive patient and family information.

A reliable telephone connection and quiet environment for conducting professional calls are necessary for this remote position.

Nice to have

Preferred candidates will have experience with Medicaid and Medicare authorization workflows and payer-specific documentation guidelines.

Experience using healthcare operations platforms or prior authorization software is highly valued for this role.

Background in family-led care models or home-based healthcare services is considered a strong advantage.

Familiarity with state-specific home care regulations and compliance requirements is preferred.

Candidates with basic understanding of AI-native platforms and digital care coordination tools will have added relevance.

Practical notes

This is a Full-Time Remote opportunity based in the Philippines with standard business hour expectations.

No business travel is required for this position, and candidates must be available during designated working hours.

Applicants must meet the legal working requirements of the Philippines without the need for visa sponsorship.