Payer Operations Manager Denver

Job Overview

Frontera Health is committed to providing exceptional ABA healthcare services to children and families in New Mexico and Colorado. The Payer Ops Manager will lead our Payer Operations team including prior authorizations and billing operations departments while playing an individual contributor role by owning the development, maintenance, and continuous improvement of credentialing and licensing workflows and policies.

• Lead credentialing and licensing processes for BCBA, RBT, and Psychologist certifications and recertifications, ensuring new and existing hires can provide services in operating states.
• Maintain accurate records and databases of certified ABA and Psychology professionals.
• Provide support and guidance to applicants regarding the certification process and resolve application issues.
• Develop and implement a comprehensive licensing and credentialing playbook across ABA Therapy and Diagnostic service lines, including standardized processes, documentation, timelines, and resourcing.
• Collaborate with team members to identify and analyze workflows for credentialing, billing operations, and prior authorization, optimizing efficiency and reducing errors.
• Propose and implement process improvements to achieve faster turnaround times and improve service delivery.
• Oversee standard operating procedures and playbooks across teams to document processes and create clear repeatable workflows.
• Utilize data analysis and best practices to refine credentialing, billing operations, and authorization processes.
• Identify trends in claim errors and rejections to drive process improvements.
• Ensure compliance with certification and billing requirements through conducting quality assurance audits.
• Lead, manage, and develop the Payer Operations team across credentialing, billing operations, and prior authorizations.
• Build strategic roadmap for payer operations to scale practices as business expands.
• Monitor and interpret changes in regulatory guidance and billing manuals, managing the team through process updates.
• Collaborate with senior leaders to create and refine Payer Operations policies and procedures, and develop billing strategies for new or current service line opportunities.
• Serve as subject matter expert across credentialing, licensing, prior authorizations, and billing operations questions.
• Define and report on performance metrics across credentialing, billing operations, and prior authorizations.

• High school diploma or equivalent required;
  Bachelor’s degree preferred.
• 3+ years of experience in credentialing and licensing, with at least 1+ year in ABA or Psychologist specific credentialing.
• Experience managing payer relationships for an ABA or Psychology organization.
• 2+ years of people leadership experience.
• Experience reviewing documentation and ensuring compliance with standards.
• Knowledge of relevant laws, regulations, and ethical standards in behavior analysis.
• Experience working in EHR systems such as Motivity or Passage Health is a plus.
• Experience with CRM tools, including Lead Squared or similar platforms.
• Proficient in Google Suite (docs, calendar, sheets).
• Proficient in Microsoft Excel, Google Sheets, or similar software.
• Proficient in Availity and EHRs.
• Excellent organizational, time management, and communication skills.

Frontera Health offers a competitive benefits package including health insurance, dental insurance, vision insurance, paid time off, and more.

$105,000 - $125,000 USD

As set forth in Frontera Care’s Equal Employment Opportunity policy, we do not discriminate on the basis of any protected group status under any applicable law.