Job Description

Job Description

Alto is looking for an experienced Prior Authorization Specialist to manage the day to day submission and follow-up of prior authorizations for patients and providers. In this role, you will help Alto develop a playbook to efficiently handle prior authorizations in a manner that best serves our patients and provider. As such, you will ideally have extensive experience working at a doctor’s office, pharmacy, or insurer where they developed prior authorization best practices and gained specialist knowledge specific to disease states and insurance plans. You will also be responsible for developing thorough knowledge of each Doctor and clinic’s services, best practices, and patient needs. The knowledge you accumulate will be used to contact providers and insurance help desks by phone and internal messaging to review prior authorization needs, conduct benefit investigations, and follow up on determination statuses.

This is a 5-day role with flexibility to work from anywhere in the US. We are looking for someone who is able to work around 40 hours per week (paid on an hourly or weekly basis).

If you join, you will:

• Validate patient’s insurance plans, prescriptions, and eligibility.
• Submit and manage prior authorizations for various disease states and clinics to specific timelines
• Communicate determinations to providers in compliance with state and federal requirements
• Identify potential quality of care issues, service, or treatment delays and intervene where clinically appropriate
• Collate and review supporting information from prescribers and attach relevant documents to prior authorizations
• Collaborate with and teach other team members best practices for managing and submitting prior authorizations

Requirements:

• 2+ years experience working in a high volume health system or specialty pharmacy OR specialist medical practice
• Exceptional knowledge of commercial and government insurance and how to troubleshoot prior authorizations
• Demonstrable ability to learn and operate new software systems and other relevant technology, including Google Suite (Sheets, Docs, etc.)
• Ability to interpret, transcribe, and troubleshoot prescription information and perform common math calculations
• Experience submitting and managing Prior Authorizations
• Excellent communication skills, knowledge of general clerical duties, and cultural competency for communicating with people of various backgrounds
• Excellent customer service skills; communicates clearly and effectively with great attention to detail

We are an equal opportunity employer and value diversity of all kinds. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender, gender identity and expression, national origin, age, disability or protected veteran status. We celebrate diversity and are committed to creating an inclusive environment for all of our associates.