Prior Authorization Manager

Alpaca Health, Inc.; New York (NY); Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

Impact on patient outcomes

Rapid career growth

Startup environment

Tech-first platform

Job summary

Alpaca Health, a remote-friendly US-based health innovator, is seeking a Prior Authorizations Manager to lead ABA intake and authorization workflows for multiple payors. This full-time position is remote and requires deep knowledge of pre-certification processes and payer requirements within autism care.

You will collaborate with providers, patients, and payors to resolve complex cases, streamline documentation, and improve authorization outcomes across regions, driving efficiency and

Qualifications

• 5+ years of experience in ABA intake with a focus on Prior Authorizations or Insurance Certification.
• Strong understanding of ABA pre-certification for Tricare East, Medicaid MCOs, BCBS State plans, Aetna, and/or Cigna.
• Highly organized with relentless follow-through and attention to detail.
• Ability to read complex clinical documents, payer feedback, and EHR data related to prior authorizations.
• Excellent written and verbal communication with families, clinicians, and payor contacts.
• Problem-solving mindset with ability to fix issues quickly.
• Comfortable with ambiguity and making sound judgments in real time.
• Maintain high standards while being approachable and supportive.

Responsibilities

• Coordinate with Prior Authorizations vendor to resolve complex issues with providers, patients, and payors.
• Serve as the in-house expert for all prior authorizations and pre-certification requirements for regions/payors.
• Support the team in gathering documentation, resolving auth rejections, and navigating payer requirements.
• Identify bottlenecks across intake workflow with operations.
• Develop training materials for offshore team members to resolve daily authorization issues.
• Own authorization outcomes and KPIs for your region/payors.

Skills

ABA intake

Prior Authorizations

Insurance Certification

Organized

Attention to detail

Clear communication

Problem-solving

Ambiguity tolerance

Team collaboration

Job description

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