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Alto // digital pharmacy
San Francisco, CA, United States    Posted: Thursday, February 13, 2020
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About the role

Alto is looking for an experienced Prior Authorization Specialist to manage the day to day submission & follow-up of prior authorizations for patients & providers. The ideal candidate will have extensive experience working at a doctors office, pharmacy, or insurer where they developed prior authorization best practices & gained specialist knowledge specific to disease states & insurance plans. This role involves working both autonomously & cross functionally with internal teams to ensure patients & providers receive the care & attention they need. If you thrive on working with new technology, applying your existing domain knowledge, & developing new internal standards, this is the role for you!

What you would do

  • Submit & manage prior authorizations for various disease states & clinics to specific timelines
  • Develop thorough knowledge of each Doctor & clinics services, best practices, & patient needs
  • Contact providers & insurance help desks by phone & internal messaging to review prior authorization needs, conduct benefit investigations, & follow up on determination statuses
  • Communicate determinations to providers in compliance with state & federal requirements
  • Collate & review supporting information from prescribers & attach relevant documents to prior authorizations
  • Identify potential quality of care issues, service, or treatment delays & intervene where clinically appropriate
  • Collaborate with & teach other team members best practices for managing & submitting prior authorizations
  • Help Alto develop a playbook to efficiently handle prior authorizations in a manner that best serves our patients & providers


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

Alto Pharmacy is an Equal Opportunity Employer & 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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