About the role

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. The ideal candidate will 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. This role involves working both autonomously and cross functionally with internal teams to ensure patients and providers receive the care and attention they need. If you thrive on working with new technology, applying your existing domain knowledge, and developing new internal standards, this is the role for you!

What you would do

  • Submit and manage prior authorizations for various disease states and clinics to specific timelines
  • Develop thorough knowledge of each Doctor and clinic’s services, best practices, and patient needs
  • 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
  • Communicate determinations to providers in compliance with state and federal requirements
  • Collate and review supporting information from prescribers and attach relevant documents to prior authorizations
  • Identify potential quality of care issues, service, or treatment delays and intervene where clinically appropriate
  • Collaborate with and teach other team members best practices for managing and submitting prior authorizations  
  • Help Alto develop a playbook to efficiently handle prior authorizations in a manner that best serves our patients and providers

Requirements

  • Been an Altoid for at least 6 months or external with 2+ years PA experience
  • 2+ years experience managing prior authorizations for an MD office (preferred), pharmacy or insurer is preferred
  • Possess knowledge of common insurance formularies, reject codes, ICD9 and ICD10 codes, and best practices for submitting prior authorizations
  • Experience working with CoverMyMeds is a plus
  • Exceptional knowledge of commercial and government insurance and how to troubleshoot claims
  • Friendly disposition and outstanding customer service skills
  • Ability and enthusiasm to learn and operate a new pharmacy management system and other relevant equipment
  • Ability to independently interpret, transcribe and troubleshoot prescription information, labs and charts
  • High school diploma / GED
  • Pharmacy Technician License or PTCB is a plus

Alto Pharmacy is an Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status, or any other legally protected basis.  

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