Prior Authorization Manager

Alpaca Health • United States, NY

3d • Remote

About The Position

Alpaca Health is hiring a full-time, remote Prior Authorization Manager based in the United States. The company supports clinicians in launching and scaling clinics, initially in autism care, through AI-powered software, payer contracting, and back-office infrastructure.

The Prior Authorization Manager will own prior authorization outcomes and KPIs for an assigned region or set of payors. The role works with the company’s prior authorizations vendor and internal operations team to resolve complex authorization issues, coordinate with providers, patients, and payors, and improve intake workflows. The manager will also develop processes and training materials so offshore team members can handle routine authorization issues.

Requirements

• At least 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, persistent follow-through, and the ability to ensure nothing falls through the cracks.
• Exceptional attention to detail and ability to interpret complex clinical documents, payor feedback, and EHR data related to prior authorization workflows.
• Clear, confident communication with parents, clinicians, and payor contacts.
• Problem-solving ability, including identifying issues and resolving them.
• Comfort working with ambiguity and making sound judgment calls in real time.
• Ability to maintain high standards while remaining approachable and supportive.

Responsibilities

• Work with the Prior Authorizations vendor to resolve complex authorization issues, coordinating with providers, patients, and payors.
• Serve as the in-house expert on prior authorization and pre-certification requests and requirements for a region or set of payors.
• Support the team in obtaining documentation, resolving authorization 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 to help offshore team members resolve day-to-day prior authorization issues.
• Own prior authorization outcomes and KPIs for the assigned region or payors.

Benefits

• Opportunity to materially impact the health outcomes of vulnerable populations.
• Opportunity for rapid career growth while building a new function at Alpaca Health.
• Opportunity to join a rapidly growing healthcare startup and a team building a scalable digital health platform.

What This Job Offers

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