Prior Authorization Specialist

Job not on LinkedIn

🔥 1 hour ago

🇵🇭 Philippines – Remote

💵 $500 - $1k / month

⏰ Full Time

🟡 Mid-level

🟠 Senior

✨ Prior Authorization Specialist

👻 Ghost score 20%

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Alpaca Health

WebsiteLinkedInAll Job Openings

2 - 10 employees

Founded 2024

🏥 Healthcare

👥 B2C

Healthcare • B2C

Alpaca Health is a provider network that delivers personalized Applied Behavior Analysis (ABA) therapy for children with autism spectrum disorder and developmental delays. They connect families with local, independent clinicians (BCBAs and therapists) and offer flexible care models — in-home, in-clinic, in-school, in-daycare, in-community, and virtual sessions — designed to integrate into a family’s daily routine. Alpaca Health provides diagnostic support (including free online screening tools and ADOS-2 assessments for young children), accepts many major insurance plans and is in-network with 100+ payers across states such as Texas, Colorado, North Carolina, and Hawaii.

📋 Description

• Own the authorization process for complex cases, with expertise in TRICARE, including ECHO enrollment and prior authorization workflows • Manage escalations from prior authorizations vendor Silna • Support documentation follow-up, authorization rejection resolution, and navigation of payer requirements • Partner with billing and insurance operations to resolve issues • Ensure timely and clear communication among families, BCBAs, referring physicians, and internal teams • Set expectations with families regarding timelines, documentation requirements, and next steps • Handle high-stakes or escalated family situations • Identify bottlenecks and inefficiencies across the intake workflow with operations • Own process improvements from identification through implementation • Maintain accurate tracking and reporting across systems

🎯 Requirements

• 5+ years of experience in ABA intake • Specific focus on prior authorizations highly preferred • Direct experience with TRICARE authorizations, including ECHO enrollment and prior authorization workflows • Highly organized with strong follow-through • Clear and confident communication with families, clinical staff, and referring physicians • Problem-solving ability • Ability to make sound judgment calls in real time amid ambiguity • Approachable and supportive while maintaining high standards

🏖️ Benefits

• Opportunity to materially impact how quickly families access care • Operational excellence directly translates to patient outcomes • Participation in a critical function at an early-stage, fast-growing company • Join a team of high-performing professionals in the ABA space

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