Prior Authorization Manager

Alpaca Health • Full-time • Remote • $75k - $95k / year • 1m ago

This role is full-time, remote, and based in the United States

Role: Prior Authorizations Manager

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

Who You Are

[REQUIRED] 5+ years of experience in ABA intake with a specific focus on Prior Authorizations or Insurance Certification
[REQUIRED] Strong understanding of the ABA pre-certification process for Tricare East, Medicaid MCOs, BCBS State plans, Aetna, and/or Cigna
You are 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
You communicate clearly and confidently with everyone from parents to clinicians to payor contacts
You are a problem-solver - you identify the issue and fix it
You are comfortable with ambiguity and can make good judgment calls in real time
You hold yourself to a high bar while remaining approachable and supportive

Why Join

The 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