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. 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.
Accelerate Your Career As You:
- 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
A Bit About You:
- 2+ years experience working in a high volume pharmacy
- An active pharmacy technician license (PTCB) in good standing with the State of Colorado, free of any disciplinary actions
- Exceptional knowledge of commercial and government insurance and how to troubleshoot claims
- Demonstrable ability to learn and operate a new pharmacy management system and other relevant technology
- Ability to interpret, transcribe, and troubleshoot prescription information and perform common math calculations
- Experience submitting and managing Prior Authorizations and TAR's, as well as specialty claims adjudication
- History of demonstrated Prior Authorization work experience
Additional Physical Job Requirements:
- Read English, comprehend, and follow simple oral and written instructions. The worker is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading. Assessing the accuracy, neatness and thoroughness of the work assigned.
- Communicating with others to exchange information. Expressing or exchanging ideas by means of the spoken word; those activities where detailed or important spoken instructions must be conveyed to other workers accurately, loudly, or quickly.
- Perceiving the nature of sounds at normal speaking levels with or without correction, and having the ability to receive detailed information through oral communication, and making fine discriminations in sound.
- Frequent repeating motions required to operate a computer that may include the wrists, hands and/or fingers.
- Sedentary work: Sitting most of the time, exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Walking and standing are required only occasionally.
Salary Range: $18.87 - $21.00
Commission Eligible: No
Equity Eligible: Yes
Benefits: Medical, Dental, Vision, 401(k), Group Life, AD&D, Employer paid STD/LTD, generous PTO and parental leave.