In 1989 Otto took a position at the A.H. Robins Company in Richmond as their first Manager of Managed Health Care and later as their Manager of New Product Planning. Although he only spent a year with A.H. Robins, it provided him with an inside view on how prescription drugs are priced, marketed and rebated with the insurance industry.

Following a brief return to community practice once Robins merged with American Home Products, Otto joined the faculty and was named Director of Experiential Education at the newly created Bernard J. Dunn School of Pharmacy at Shenandoah University. While working at Shenandoah, Otto earned his Doctor of Pharmacy degree and served as President of the Virginia Pharmacists Association.

In 2003, Otto returned home and purchased his father's pharmacy to continue the family tradition of serving the community until 2021. He was a member of the Stony Creek Volunteer Fire Department for 16 years and is a current member of the Joyner Gray Yale Ruritan Club. Otto and his wife Judy raised their two daughters and are now grandparents to two wonderful grandchildren. Over the years, Otto has helped thousands of Southside families and has seen firsthand how the loss of jobs and opportunity in the region has negatively impacted the local community. As our Delegate since 2022, Otto has worked to bring more resources into our community so the 83rd District is the best place to work, live, and raise a family. He currently serves on the Privileges and Elections Committee, Counties, Cities, and Town Committee, and the Health, Welfare, and Institutions Committee. During his first session, Otto was named one of the most effective legislators in Richmond.