[Hiring] Prior Authorization Manager @Alpaca Health

Role Description

The Prior Authorizations Manager will be responsible for:

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

Qualifications

• 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 regarding prior authorization workflows.
• Clear and confident communication with everyone from parents to clinicians to payor contacts.
• Problem-solver who identifies issues and fixes them.
• Comfortable with ambiguity and able to make good judgment calls in real time.
• Holds oneself to a high bar while remaining approachable and supportive.

Benefits

• 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.