Payer Operations Manager

FronteraCare delivers life-changing autism services to children and families across New Mexico and Colorado. We provide high quality diagnostic evaluations and ABA therapy, partnering closely with parents, grandparents, foster parents, and other caregivers to create individualized care plans rooted in each child's unique strengths, needs, and family context.
Our clinicians are committed to evidence-based, compassionate care that helps children with autism thrive. We believe the best outcomes are when families are at the heart of the treatment. By combining clinical expertise with family insights, we help children build skills, gain confidence, and thrive.

Our Mission
Our mission is to expand access to exceptional diagnostic and behavioral healthcare for every child, no matter where they live or their circumstances.

About Frontera Health and the Role:
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.

Responsibilities:
Credentialing

• Manages the credentialing and licensing processes for Board Certified Behavior Analyst (BCBA), Registered Behavior Technician (RBT), and Psychologist certification and recertification, ensuring that new and existing hires are able to provide services in the states we operate in.
• Maintains accurate records and databases of certified ABA and Psychology professionals.
• Provides support and guidance to applicants regarding the certification process.
• Communicates with applicants and resolves issues related to their applications.

• Develop and implement a comprehensive licensing and credentialing playbook across our ABA Therapy and Diagnostic service lines:

• This playbook will outline a standardized licensing and credentialing process that can be scaled across states.

• The playbook will detail all crucial aspects of credentialing, including:
• Processes: Step-by-step procedures for each stage of the credentialing process.
• Documentation: A clear list of all required documentation for different credentialing types.
• Timelines: Defined timelines for each stage of the process to ensure efficiency.
• Resourcing: Identification of resources needed to complete the credentialing process effectively.

Process Improvement:

• 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 operation procedures and playbooks across teams to appropriately document processes to 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

Leadership & Management

• Ensures compliance with certification and billing requirements and standards through conducting quality assurance audits to ensure continuous adherence to standards.
• 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 with focus on payer relationships and best practices for maximizing billing.
• Monitors and interprets changes in regulatory guidance and billing manuals, while managing the team through implementing process updates as needed

• Collaborates with senior leaders to:

• Create and refine Payer Operations policies and procedures.

• 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

Qualifications:

• 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 in 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 LeadSquared 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.

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

Why Join Us
At Frontera Care, you will be part of a mission-driven, supportive team making a real difference for children and families. We provide the tools, resources, collaboration you need to focus on what matters most: delivering high-quality, family-centered care. If you are passionate about helping children with autism, and want to grow your career while transforming access to care, accessible healthcare, we would love to welcome you to our team.