Prior Authorization Manager
Alpaca Health
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
- ...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...SuggestedFull timeRemote workShift work
$70k - $82k
...Route faxes that aren’t referrals, like records requests, prior authorizations and labs, to the right owner. Other duties as assigned by... ...Qualifications ~3+ years leading a team in patient access, referral management, scheduling or a similar high-volume healthcare operation....SuggestedFull timeTemporary workPart timeLocal areaRemote work$75.7k - $108.1k
...flexibility, learning, and career development. Summary As a Manager at Gainwell, you will be part of an innovative product... ...guidelines ~ Minimum of two years’ Medicaid experience in Prior Authorization/Utilization Review preferred. ~ Proficient with...SuggestedFull timeWork at officeRemote workFlexible hours$87k - $161.3k
...Position Purpose: Manages Prior Authorization, Concurrent Review, Retrospective Review Clinical Review and/or Appeals team to ensure appropriate care to members. Manages utilization management issues related to member care, provider interactions, and facilitates operations...SuggestedFull timePart timeWork at officeRemote workFlexible hoursWeekend work$152.25k - $253.75k
...Patient Access Manager (PAM) Position Summary: The Patient Access Manager is a field-based single point of contact (SPOC) helping... ...the office level: explain benefit investigation outcomes, prior authorization requirements and processes, and appeal pathways, with the...SuggestedFull timeWork at officeLocal areaRemote workNight shift$66.46k - $129.59k
...professionals in some or all of the following functions: care management, utilization management, behavioral health, care... ...services functions: care management, utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), transition...Full timeContract workWork at officeLocal areaRemote work$131.89k - $178.44k
...Job Description Patient Access & Reimbursement Marketing Manager, - Biosimilar Join Amgen’s Mission of Serving Patients... ...formulary coverage, utilization management requirements (e.g., prior authorization and step therapy), reimbursement, and patient support services...Full timeFlexible hours$190k - $225k
...is determined by considering a person's prior experience and competence. The... ...strategic direction to the Field Reimbursement Management (FRM) and Hub Services organizations... ...reimbursement pathways, coding, billing, prior authorizations, and appeals processes. Knowledge,...Minimum wageFull timeTemporary workWork at officeLocal areaRemote workFlexible hoursNight shift- ...practices around formulary and coverage management in the Commercial and Medicare... ...engagements. The position will also require prior leadership and management experience to... ...that payers use when developing Prior Authorizations, step-therapy edits and other drug coverage...Full timeFreelance
$122.25k - $176.58k
...Job Title: Field Reimbursement Manager - Pulmonary and Gastroenterology - San Francisco & Sacramento, CA Location: Remote, US... ...expert relating to patient support, access, reimbursement, prior authorization, appeal, financial assistance, and other business related issues...Full timeWork at officeLocal areaRemote work$174.07k - $374.92k
...of clinical / medical programs and expand Aetna's medical management programs to address member needs across the continuum of care... ...responsible for predetermination reviews. This includes Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer...Hourly payFull timeTemporary workLocal areaRemote workWork from home$105k - $181.7k
...Solutions (PECS) team is recruiting for a Field Reimbursement Manager which will be a field-based position. This is a field-based... ...may be assigned. Educate HCPs on product coverage, prior authorizations and appeals, reimbursement processes, claims submissions, procedures...Permanent employmentFull timeWork at officeLocal areaImmediate start$145.47k - $196.81k
...patients while transforming your career. Field Reimbursement Manager – Seattle, Washington What you will do Let’s do this. Let’s... ..., supporting the entire reimbursement journey through payer prior authorization to appeals/denials requirements and forms Review patient-...Full timeLive inWork at officeRemote workWork from homeRelocationHome officeFlexible hours2 days per week$153.94k - $199.21k
...threatening illnesses worldwide. The Senior Field Reimbursement Manager – HIV Prevention is a highly specialized, priority account-... ...impacting multiple sites, including benefit verification, prior authorization, medical exception, claims, acquisition, specialty pharmacy,...Full timeFor contractorsWork at officeLocal areaRemote workWorldwide$187.4k - $281k
...Build relationships with medical directors, laboratory benefit managers (LBMs), reimbursement leaders, and payer policy teams.... ...commercial payer medical policy development, evidence requirements, prior authorization, coding, and reimbursement. Excellent strategic planning,...Full timeLocal area- ...primary purpose of this position is to provide day-to-day case management oversight and coordination of assigned caseload to ensure... .... The Case Manager is responsible for ensuring prior authorizations, reauthorizations and appeals are obtained in a timely manner...Full timeTemporary workWork experience placementWork at officeLocal areaRemote workFlexible hoursShift work
$109.5k - $208.5k
...San Francisco, CA San Jose, CA The Field Reimbursement Manager (FRM) shares expertise and educates on Medical and Pharmacy... ...identification, clinical documentation, benefit investigation results, prior authorizations, billing, coding, patient tracking, claim submission,...Full timeLocal areaNight shift$176k - $242k
...States, Japan, and Switzerland. The Field Reimbursement Manager (FRM) serves as a trusted partner to healthcare providers and... ...of commercial and government payer policies, benefit design, prior authorization requirements, claims adjudication, appeals processes, and...Full timeTemporary workLive inWork at officeRemote work$123.3k - $166.8k
...Overview: The Field Reimbursement Manager (FRM) serves as the access and coverage subject matter expert for Alnylam products... ...education on reimbursement pathways, coverage requirements, prior authorization, appeals, and payer processes. Partner collaboratively...Full timeTemporary workWork at officeLocal areaFlexible hoursNight shift- ...Director, Field Reimbursemenet Direct Reports: None Areas Managed: Field Reimbursement Overview The Field... ...personnel, including information regarding medical policies, prior authorization requirements, coding and billing, product access via buybill...Full timeWork at officeLocal areaRemote workNight shiftWeekend work
$185k - $215k
...Market Access About This Role: The Field Reimbursement Manager plays a critical role in facilitating patient access to new... ...reimbursement criteria policies. Educate providers on prior authorization requirements, coverage status, payer appeals requirements,...Full timeContract workWork at officeLocal areaRemote work- .../AA REQUIRES APPROVAL FROM COMPENSATION PRIOR TO POSTING OR RECLASSIFICATIONThis position... ...of treatment. Responsibilities include managing the coordination of care, such as... ...accurate and timely completion of prior authorizations for tests, imaging, and procedures. Collaborates...Full time
$110k - $120k
...As a Senior Accountant with our Captive team, you will manage the day-to-day accounting and financial activities of a portfolio... ...Vendors must have a valid written agreement and received prior written authorization from an authorized Brown & Brown representative before...Hourly payFull time$153.94k - $199.21k
...threatening illnesses worldwide. The Senior Field Reimbursement Manager – HIV Prevention is a highly specialized, priority account-... ...impacting multiple sites, including benefit verification, prior authorization, medical exception, claims, acquisition, specialty pharmacy,...Full timeFor contractorsWork at officeLocal areaRemote workWorldwide$100k - $175k
...VT, NH, MA,RI About the Role The Field Reimbursement Manager (FRM) is a key contributor to the overall patient support program... ..., with a focus on patient support, access, reimbursement, prior authorization, appeal, financial assistance, and other business-related...Full timeTemporary workWork at officeRemote workWeekend workAfternoon shift$50k
...ME, NH, MA, RI, CT, & Metro NY As a Field Reimbursement Manager (FRM), you will join our team on a journey to help eliminate... ...benefit reimbursement, access, and coverage issues including Prior Authorization and Appeals. Responsibilities Solve complex patient access...Full timeTemporary workWork at officeLocal areaImmediate start- ...access, or healthcare commercialization Deep experience with commercial payer reimbursement for devices and surgical products Proven track record in HOPD and physician office settings Strong expertise in coding, coverage, payment, and prior authorization processes...Full timeWork at officeRemote work
Virtual Vocations Inc
United States1 day ago - ...GENERAL MANAGER FLSA Classification: Exempt Reports to: District Manager Benefits: Major Medical – Aetna Dental... ...occasionally travel. You may also be permitted to work remotely with prior authorization from your manager. Reliable transportation required, and...Full timeSeasonal workRemote workFlexible hoursShift workNight shiftWeekend workDay shift
Nothing Bundt Cakes
Newnan, GA1 day ago $190k - $220k
...Oracle Technical Project Manager — E-Business Suite and Fusion Center of Excellence | Working alongside Tessera AI Agents... ...represent that they are acting on behalf of Tessera Labs without prior written authorization. Any such activity conducted without explicit written...Long term contractFull timeWork at officeImmediate startRemote work$50k
...to a real person who is looking for thorough and efficient management of their records. You'll adjust your approach to their needs... ...This includes completing benefit investigations, tracking prior authorizations / denial appeals, and assisting patients or other callers/stakeholders...Full timeTemporary workWork at officeImmediate startRemote workWork from homeShift work
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Prior Authorization Manager. Be the first to apply!
