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Strategy and Operations Lead - Insurance Operations

Alpaca HealthNew York City, NY
On-site Full-time

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Experience Level

Mid to Senior

Qualifications

Qualifications:Strong analytical and problem-solving skills. Proven experience in operational management, particularly in healthcare or insurance. Excellent communication and interpersonal abilities. Ability to work collaboratively in a fast-paced environment. Familiarity with healthcare regulations and payer systems.

About the job

About Alpaca Health

At Alpaca Health, we empower clinicians to become entrepreneurs in the field of autism care. Our mission is to transition the power in healthcare from large, consolidated entities back to individual clinicians.

We provide innovative AI-powered software, payer contracting, and comprehensive back-office infrastructure to help clinicians successfully launch and scale their own clinics. Our commitment is to tackle complex operational challenges that are crucial for families.

We are rapidly expanding into new states and have raised over $14 million from prominent early-stage investors, including Core Innovation Capital, Adverb Ventures, and South Park Commons. Our growth trajectory is impressive, serving hundreds of patients while achieving a 30% month-over-month growth rate.

Role: Strategy and Operations Lead

We are seeking a Strategy and Ops Lead who can navigate the complexities of insurance processes. In this role, you will transform disorganized insurance feedback into streamlined processes and scalable systems, bridging operations and product to leverage technology for standardizing workflows and enhancing execution reliability.

Ideal candidates will be detail-oriented, finding intrigue in unusual edge cases rather than being deterred by them.

What You’ll Do

Manage Prior Authorization Operations
Oversee daily workflows for prior authorizations across various providers and payers, partnering with them to resolve issues and ensure timely submissions and approvals.

Enhance the Prior Authorization System
Collect and analyze provider feedback to pinpoint process failures, translating insights into product and workflow enhancements that boost approval rates and processing speed.

Standardize Payer Requirements
Develop and maintain an organized repository for payer-specific documentation requirements, continuously refining standards to minimize denials and rework.

Oversee Reassessments and Authorization Timelines
Monitor authorization periods and reassessment deadlines for patients, ensuring proactive renewals to avoid gaps in care and revenue loss.

Research Complex Payer Pathways
Explore and operationalize single case agreements and out-of-network billing strategies, crafting playbooks for unique cases and non-standard payer situations.

About Alpaca Health

Alpaca Health is at the forefront of empowering clinicians to take charge of their practice in autism care. By providing cutting-edge software and operational support, we enable healthcare professionals to focus on what matters most – delivering exceptional care to patients.

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