Prior Authorization Manager

Job not on LinkedIn

🔥 1 hour ago

🗽 New York – Remote

🗽 New York – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 25%

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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

• Work with the Prior Authorizations vendor to resolve complex authorization issues • Coordinate with providers, patients, and payors • Serve as the in-house expert for prior authorizations and pre-certification requests and requirements for a region or set of payors • Support the team in obtaining documentation, resolving authorization rejections, and navigating payer requirements • Work with the operations team to identify bottlenecks, inefficiencies, and opportunities in the intake workflow • Develop processes and training materials for offshore team members handling day-to-day prior authorization issues • Own Prior Authorization outcomes and KPIs for the assigned region or payors

🎯 Requirements

• 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 • Extreme attention to detail and ability to read complex clinical documents, payor feedback, and EHR data related to prior authorization workflows • Clear and confident communication with parents, clinicians, and payor contacts • Problem-solving ability • Comfort with ambiguity and real-time judgment • Must be a US Citizen, Green Card Holder, or eligible for a TN Visa; the application asks about current or future visa sponsorship requirements • Required phone number and resume for application

🏖️ Benefits

• Opportunity to materially impact the health outcomes of the most vulnerable populations • Opportunity for rapid career growth as Alpaca Health builds out a new function • Join a fast-growing healthcare startup • Join a team taking a technology-first approach to building a scalable digital health platform

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