Prior Authorization Manager

Alpaca Health

• $90K — $120K *
New York, NY 10025In-Person
Healthcare
5 - 7 years of experience
Today
Be an Early Applicant
Job Overview by Ladders

Qualifications

  • 5+ years of experience in ABA intake with a 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 with exceptional follow-through
  • Detail-oriented with ability to analyze complex clinical documents and EHR data
  • Clear and confident communicator with diverse stakeholders
  • Strong problem-solving skills and ability to make quick judgment calls
  • Approachable and supportive with high personal standards

Responsibilities

  • Resolve complex authorization issues with the Prior Authorizations vendor and coordinate with providers, patients, and payors
  • Act as the in-house expert on prior authorizations and pre-certification requests for specific payors
  • Assist the team in obtaining documentation and resolving authorization rejections
  • Identify workflow bottlenecks and inefficiencies with the operations team
  • Create processes and training materials for offshore team members
  • Take ownership of Prior Authorization outcomes and KPIs for assigned regions/payors

Benefits

  • Opportunity to impact health outcomes for vulnerable populations
  • Rapid career growth potential as a new function develops at Alpaca Health
  • Work in one of the fastest growing healthcare startups with notable monthly growth
  • Collaborate with a high-performing team focused on a tech-driven digital health platform
Full Job Description
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
* Ladders Estimates

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