Prior Authorization Manager

About this role

📌 ABOUT ALPACA HEALTH

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

🎯 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

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