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About the Role
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. This role is critical in managing prior authorizations and ensuring smooth operations for our clinicians and patients.
Responsibilities
- Work with the Prior Authorizations vendor to resolve complex authorization issues, coordinating with providers, patients, and payors.
- Serve as the in-house expert for all prior authorizations and pre-certification requests and requirements for a specific region or set of payors.
- Support the team in obtaining documentation, resolving authorization rejections, and navigating payer requirements.
- Collaborate with the operations team to identify and address bottlenecks, inefficiencies, and opportunities within the intake workflow.
- Develop processes and training materials for offshore team members to handle day-to-day prior authorization issues.
- Own Prior Authorization outcomes and KPIs for the assigned region/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 with a relentless focus on follow-through.
- Extreme detail orientation and ability to interpret complex clinical documents, payor feedback, and EHR data related to prior authorization workflows.
- Clear and confident communication skills with diverse stakeholders including parents, clinicians, and payor contacts.
- Proven problem-solving abilities, identifying and resolving issues effectively.
- Comfort with ambiguity and ability to make sound judgment calls in real-time.
- High personal standards for performance, while remaining approachable and supportive.
Skills
- Prior Authorizations
- Insurance Certification
- ABA intake
- Tricare East
- Medicaid MCOs
- BCBS State plans
- Aetna
- Cigna
- Process development
- Training material development
- Workflow analysis
- Communication
- Problem-solving
- Attention to detail
Location
- United States
Work Type
- Full-time
- Remote
Experience Level
- 5+ years
Benefits
- Opportunity to materially impact health outcomes for vulnerable populations.
- Potential for rapid career growth as a new function is built.
- Involvement in a fast-growing healthcare startup with significant monthly growth.
- Collaboration with high-performing individuals in a tech-first approach to digital health.
About the Company
- Alpaca Health enables clinicians to become entrepreneurs, starting in autism care.
- Provides AI-powered software, payer contracting, and full back-office infrastructure to help clinicians launch and scale their own clinics.
- Aims to shift power in healthcare from large entities back to clinicians.
- Has raised over $14M in funding from investors including Core Innovation Capital, Adverb Ventures, and South Park Commons.
- Is building for long-term category leadership.
- Is serving thousands of patients and experiencing 30% - 50% month-over-month growth.