Prior Authorization Manager

Alpaca Health • United States, NY

9d • Remote

About The Position

Alpaca Health enables clinicians to become entrepreneurs, starting in autism care. We help clinicians launch and scale their own clinics by providing AI-powered software, payer contracting, and full back-office infrastructure. Our goal is simple: shift power in healthcare away from large consolidated entities and back to clinicians. We've raised over $14M in funding from early-stage investors like Core Innovation Capital, Adverb Ventures, and South Park Commons, and are building for long-term category leadership. More importantly, we're serving thousands of patients, while growing 30% - 50% MoM. This role is full-time, remote, and based in the United States.

Requirements

• 5+ years of experience in ABA intake with a specific focus on Prior Authorizations or Insurance Certification
• Strong understanding of the ABA pre-certification process for Tricare East, Medicaid MCOs, BCBS State plans, Aetna, and/or Cigna
• Highly organized and relentless about follow-through, nothing falls through the cracks on your watch
• Extreme detail orientation and ability to read complex clinical documents, payor feedback, and EHR data with regards to prior authorization workflows
• Communicate clearly and confidently with everyone from parents to clinicians to payor contacts
• Problem-solver - identify the issue and fix it
• Comfortable with ambiguity and can make good judgment calls in real time
• Hold yourself to a high bar while remaining approachable and supportive

Responsibilities

• Work with our Prior Authorizations vendor to resolve complex authorization issues including coordinating with our providers, patients and payors
• Be the inhouse expert for all prior authorizations and pre-certification requests and requirements for a region or set of payors
• Support the team in chasing down documentation, resolving auth rejections, and navigating payer requirements
• Work with the operations team to identify bottlenecks, inefficiencies, and opportunities across the intake workflow
• Develop processes and training materials for offshore team members to resolve day-to-day prior authorization issues
• Own Prior Authorization outcomes and KPIs for your region / payors

Benefits

• Opportunity to materially impact the health outcomes of the most vulnerable populations
• Opportunity for rapid career growth as we build out a net new function at Alpaca Health
• Join one of the fastest growing healthcare startups in the world (between 30% - 50% monthly growth)
• Join a team of rockstar performers who are taking a new tech first approach to building a scalable digital health platform

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed