Prior Authorization Workflow Consultant

This is a fully remote position, open to applicants in United States.

📋 Description

• Take ownership of the operational workstream deliverables for customer implementations, which encompass discovery, data collection, and analysis of Prior Authorization workflows.

• Actively oversee all operational workstream tasks outlined in the implementation project plan.

• Be a cooperative and communicative participant in the implementation project team, ensuring that the implementation project manager is informed about operational progress and potential risks.

• Facilitate operational workflow and portal shadowing sessions with customers, posing insightful and specific questions to grasp their current processes. Identify risks that may affect the successful implementation of Humata’s PA technology.

• Record and document operational workflows in Humata’s design workbook to guide solution development and establish prior authorization workflows. Review customer payer/plan mix and create automation workflow recommendations.

• Modify future-state workflows and payer/portal additions for customers during the stabilization and maintenance phases after go-live.

• Generate payer portal credentials to enhance Humata’s automation capabilities.

• Oversee payer portal validation during testing and go-live phases; work alongside the customer’s operations/technical teams to evaluate automation outcomes.

• Document and escalate validation issues for review and resolution by Humata’s Engineering team.

⛳️ Requirements

• A Bachelor’s degree in Business, Healthcare Administration, or a related field.

• Over 3 years of hands-on experience in Prior Authorization.

• Knowledge of healthcare operations, prior authorization processes, or revenue cycle workflow optimization.

• Expertise with systems such as Epic (including referrals, work queues, and coverage), payer portals, and revenue cycle operations.

• Practical experience in data analysis, capable of evaluating referral volumes per service line/payer. This role necessitates a strong analytical mindset to synthesize large data sets and make data-driven decisions.

• Highly organized, able to document processes (both current and future-state automations) effectively.

• Comfortable with uncertainty, changing priorities, and establishing new processes in a dynamic startup environment.

• A collaborative team player with a consultative approach to client engagement and solution development.

• Proficient in PowerBI for reporting, Google Workspace, and Slack.

• Willingness to travel as needed (up to 25%) for customer onsite discovery sessions and all-company meetings.

🏝️ Benefits

• Impactful Work: Contribute to innovative solutions that enhance healthcare efficiency and improve patient outcomes.

• Remote Flexibility: Enjoy the benefits of remote work while being part of a collaborative team, with access to our new office in Winter Park, FL.

• Competitive Compensation: Receive competitive base pay, equity through our Employee Stock Option Plan, and roles that are eligible for bonuses.

• Comprehensive Benefits: Access a full benefits package that includes unlimited PTO and a 401k program with employer matching.

• Growth Opportunities: Advance your career in a fast-paced, high-impact environment with plenty of professional development options.

• Inclusive Culture: Join a diverse workplace where your ideas and contributions are appreciated.