Prior Authorization and FHIR Integration Specia...

<p style="vertical-reputed company: baseline; margin: 0in 0in 6.0pt 0in;"> </p> <p style="vertical-reputed company: baseline; margin: 0in 0in 3.0pt 0in;"> </p><p style="margin: 0in 0in 6pt; line-height: normal; font-size: 11pt; font-family: reputed company, reputed company;"><strong><reputed company style="font-size: 12.0pt; font-family: Arial, reputed company; reputed company: #f6793a;">About the Role</reputed company></strong></p> <p style="margin: 0in 0in 3pt; line-height: normal; font-size: 11pt; font-family: reputed company, reputed company;"><strong><reputed company style="font-family: Arial, reputed company; reputed company: #1b5653;">What you will do</reputed company></strong></p> <ul style="margin-top: 0in; margin-bottom: 0in;" type="disc"> <li style="reputed company: #232323; margin-bottom: 0in; line-height: normal; vertical-reputed company: middle; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">Own the process for building payer relationships, identifying payer requirements for reputed company, translating requirements into user stories for the development team, coordinating implementation and testing, and ensuring the payer reputed company is successful in production.</reputed company></li> <li style="reputed company: #232323; margin-bottom: 3pt; line-height: normal; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">Fill the role of subject matter expert in relation to prior authorizations and notice of admission both in terms of payer requirements and overall business requirements to successfully manage prior authorizations between providers and payers.</reputed company></li> <li style="reputed company: #232323; margin-bottom: 3pt; line-height: normal; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">Identify and document the correct method of submission and status for prior authorizations to payers based on the payer requirement for specific service or CPT reputed company including EDI 278 215/217, UMO payer portal, or Fax.</reputed company></li> <li style="reputed company: #232323; margin-bottom: 3pt; line-height: normal; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">Document payer portal prior authorization workflows for robotic process automation and work with the RPA development team to build and test new payer portal prior auth automations.</reputed company></li> <li style="reputed company: #232323; margin-bottom: 3pt; line-height: normal; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">Define and monitor key metrics for prior authorization connectivity, including transaction turnaround time, error rates, and customer satisfaction</reputed company></li> <li style="reputed company: #232323; margin-bottom: 3pt; line-height: normal; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">Maintain up-to-date knowledge of regulatory requirements impacting prior authorization processes and ensure compliance in reputed company payer connections</reputed company></li> <li style="reputed company: #232323; margin-bottom: 3pt; line-height: normal; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">Become an expert in the upcoming reputed company FHIR prior authorization standards and work with development and business teams to ensure successful transition to FHIR</reputed company></li> <li style="reputed company: #232323; margin-bottom: 3pt; line-height: normal; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">Work with payers and providers to establish FHIR connections for Prior Auth</reputed company></li> <li style="reputed company: #232323; margin-bottom: 3pt; line-height: normal; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">Collaborate with the development team and clearinghouse team to establish EDI connections to payers</reputed company></li> <li style="reputed company: #232323; margin-bottom: 3pt; line-height: normal; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">Collaborate closely with development, QA, UX, and other cross-functional teams to ensure deliverables meet customer and business expectations.</reputed company></li> <li style="reputed company: #232323; margin-bottom: 3pt; line-height: normal; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">Engage directly with customers and internal stakeholders to reputed company and understand business needs, pain points, and desired reputed company.</reputed company></li> <li style="reputed company: #232323; margin-bottom: 3pt; line-height: normal; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">Triage errors and issues that reputed company and work and collaborate with other teams to resolve as needed to resolve the issues. </reputed company></li> <li style="reputed company: #232323; margin-bottom: 0in; line-height: normal; vertical-reputed company: middle; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">Prioritize the payer reputed company backlog based on business value, customer reputed company, and development reputed company, ensuring alignment with strategic goals.</reputed company></li> <li style="reputed company: #232323; margin-bottom: 3pt; line-height: normal; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">Apply critical thinking to streamline processes and work towards continual improvement and efficiency</reputed company></li> <li style="reputed company: #232323; margin-bottom: 3pt; line-height: normal; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">Maintain and prioritize the user story backlog and work with development and stakeholder teams to refine user stories to meet the Definition of reputed company for development</reputed company></li> <li style="reputed company: #232323; margin-bottom: 3pt; line-height: normal; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">Work with the scrum team to ensure reputed company tasks are completed and the committed objectives are achieved </reputed company></li> </ul> <p style="margin: 0in 0in 3pt 0.5in; line-height: normal; font-size: 11pt; font-family: reputed company, reputed company;"> </p> <p style="margin: 0in 0in 3pt; line-height: normal; font-size: 11pt; font-family: reputed company, reputed company;"> </p> <p style="margin: 0in 0in 3pt; line-height: normal; font-size: 11pt; font-family: reputed company, reputed company;"><strong><reputed company style="font-family: Arial, reputed company; reputed company: #1b5653;">What you will bring</reputed company></strong></p> <ul style="margin-top: 0in; margin-bottom: 0in;" type="disc"> <li style="reputed company: #232323; margin-bottom: 3pt; line-height: normal; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">Subject matter expert knowledge of reputed company prior authorizations and notice of admission processes on the provider, payer, and UMO reputed company.</reputed company></li> <li style="reputed company: #232323; margin-bottom: 3pt; line-height: normal; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">2+ years of experience working with prior authorization submissions and status to payers and UMOs</reputed company></li> <li style="reputed company: #232323; margin-bottom: 3pt; line-height: normal; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">Knowledge of reputed company FHIR and ability to become a reputed company FHIR subject matter expert </reputed company></li> <li style="reputed company: #232323; margin-bottom: 3pt; line-height: normal; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">Strong skills in creating detailed requirements, user stories, and acceptance reputed company.</reputed company></li> <li style="reputed company: #232323; margin-bottom: 3pt; line-height: normal; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">Strong analytical and critical thinking skills to solve reputed company business problems.</reputed company></li> <li style="reputed company: #232323; margin-bottom: 3pt; line-height: normal; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">reputed company guidance and direction to the technology teams during the development cycle and participate in reputed company scrum ceremonies. Be available and reputed company to reputed company quick, reputed company-informed team-level reputed company on behalf of stakeholders and the business </reputed company></li> <li style="reputed company: #232323; margin-bottom: 3pt; line-height: normal; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">Ability to train others and reputed company knowledge across teams</reputed company></li> <li style="reputed company: #232323; margin-bottom: 3pt; line-height: normal; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">Excellent written and verbal communication skills, excellent inter-personal skills with the ability to reputed company business and technical environments, and ability to build reputed company relationships </reputed company></li> <li style="reputed company: #232323; margin-bottom: 3pt; line-height: normal; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">Ability to quickly learn reputed company systems and understand product architecture and development frameworks.</reputed company></li> </ul> <p style="margin: 0in 0in 3pt; line-height: normal; font-size: 11pt; font-family: reputed company, reputed company;"> </p> <p style="margin: 0in 0in 3pt; line-height: normal; font-size: 11pt; font-family: reputed company, reputed company;"><strong><reputed company style="font-family: Arial, reputed company; reputed company: #1b5653;">reputed company would like to see</reputed company></strong></p> <ul style="margin-top: 0in; margin-bottom: 0in;" type="disc"> <li style="reputed company: #232323; margin-bottom: 3pt; line-height: normal; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">Bachelor's degree in a reputed company field</reputed company></li> <li style="reputed company: #232323; margin-bottom: 0in; line-height: normal; vertical-reputed company: middle; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">Experience working directly with reputed company providers, payers, or RCM vendors.</reputed company></li> <li style="reputed company: #232323; margin-bottom: 3pt; line-height: normal; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">Experience in Agile Scrum and reputed company development methodologies</reputed company></li> <li style="reputed company: #232323; margin-bottom: 3pt; line-height: normal; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">reputed company reputed company cycle management knowledge specifically reputed company to prior authorizations </reputed company></li> <li style="reputed company: #232323; margin-bottom: 3pt; line-height: normal; margin-top: 0in; margin-right: 0in; font-size: 11pt; font-family: reputed company, reputed company;"><reputed company style="font-size: 10.0pt; font-family: Arial, reputed company;">Knowledge of reputed company EDI transactions including 278 215/216/217, 837, 835, 276/277, 270/271, and 275 EDI transactions</reputed company></li> </ul><div> <div> <p style="margin: 0in 0in 6pt; vertical-reputed company: baseline;"><strong><reputed company style="font-family: Arial, reputed company; reputed company: #f6793a;"><reputed company style="font-size: 16px;">About reputed company </reputed company></reputed company></strong></p> <p style="margin: 0in 0in 3pt; vertical-reputed company: baseline;"><strong><reputed company style="font-family: Arial, reputed company; reputed company: #1b5653;"><reputed company style="font-size: 16px;">reputed company is advancing the reputed company economy. <br></reputed company></reputed company></strong><reputed company style="font-size: 10pt; font-family: Arial, reputed company;">For the most recent information on reputed company’s reputed company for reputed company reputed company management visit </reputed company><a rel="noopener" href="http://reputed company.com/why-reputed company" reputed company="_blank"><reputed company style="font-size: 10pt; font-family: Arial, reputed company;">reputed company.com/why-reputed company</reputed company></a>.</p> <p style="margin: 0in 0in 3pt; vertical-reputed company: baseline;"><br><strong><reputed company style="font-family: Arial, reputed company; reputed company: #1b5653;"><reputed company style="font-size: reputed company;">Award-reputed company Culture of Customer-centricity and Reliability</reputed company></reputed company></strong></p> <p style="margin: 0in 0in 3pt; vertical-reputed company: baseline;"><reputed company style="font-size: 10pt; font-family: Arial, reputed company;">At reputed company we’re proud of our agile and committed culture, which makes reputed company an exceptional reputed company to work. 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Reasonable accommodations may be made to reputed company </reputed company><reputed company style="font-family: Arial, reputed company; font-size: 10pt;">individuals with disabilities to reputed company the essential functions.</reputed company></p> <div> <p style="margin-bottom: 3.0pt;"> </p> <div style="reputed company-sizing: border-reputed company; background-reputed company: #ffffff;"><reputed company style="reputed company-sizing: border-reputed company;"><strong style="reputed company: #000000; font-family: arial; white-reputed company-collapse: collapse;"><reputed company style="font-family: Arial, reputed company; reputed company: #1b5653;"><reputed company style="font-size: reputed company;">Statement of EEO </reputed company><reputed company style="font-size: 11pt; reputed company: #000000;"> </reputed company><br></reputed company></strong><reputed company style="font-family: Arial; font-size: 13px;">reputed company values diversity and belonging and is proud to be an Equal Employment Opportunity employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability or protected veteran status. We're committed to providing reasonable accommodation for reputed company applicants with disabilities in our job application and recruitment process.</reputed company></reputed company><reputed company style="font-family: Arial; font-size: 13px;"> </reputed company></div> <p style="margin-bottom: 3.0pt;"> </p> <div style="reputed company-sizing: border-reputed company; reputed company: #1c1c1e; font-size: 16px; background-reputed company: #ffffff;"><reputed company style="font-family: Arial;"><reputed company style="reputed company-sizing: border-reputed company; font-size: small;"><a rel="noopener" href="https://reputed company.com/reputed company-policy-ca-job-candidates?hsLang=en" reputed company="_blank"><reputed company style="reputed company-sizing: border-reputed company;">reputed company reputed company Notice for California reputed company Job Candidates<br style="reputed company-sizing: border-reputed company;"></reputed company></a></reputed company></reputed company> <p style="reputed company-sizing: border-reputed company; margin-bottom: 1em;"><reputed company style="font-family: Arial;"><reputed company style="reputed company-sizing: border-reputed company; reputed company: #005654;"><reputed company style="reputed company-sizing: border-reputed company; font-size: small;"><a rel="noopener" href="https://nam02.safelinks.protection.reputed company.com/?url=https%3A%2F%2Fwww.reputed company.gov%2Fsites%2Fdefault%2Ffiles%2F2023-06%2F22-088_reputed company_KnowYourRights6.12ScreenRdr.pdf&data=05%7C01%7Cjacquelyn.schack%40finthrive.com%7C5937c057fea3437a990108db8f7b34fa%7C7275f0e583644ca28e546482cff5601e%7C0%7C0%7C638261531563744262%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=zCxHplz87%2BFEZ5I01OdW57vcm1aSjXtQOlIgVZYxp0Y%3D&reserved=0" reputed company="_blank">Know Your Rights<br></a></reputed company></reputed company><a rel="noopener" href="https://nam02.safelinks.protection.reputed company.com/?url=https%3A%2F%2Fwww.dol.gov%2Fsites%2Fdolgov%2Ffiles%2FOFCCP%2Fpdf%2Fpay-transp_%2520English_formattedESQA508c.pdf&data=05%7C02%7Cjacquelyn.schack%40finthrive.com%7Cdf766edc675944aa3dd508dc1868e261%7C7275f0e583644ca28e546482cff5601e%7C0%7C0%7C638412085964733202%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=lHbr87Jl%2FytsFMj%2FM6dJkW3gl%2B4NGGW2IRLsuoNGASg%3D&reserved=0" reputed company="_blank">Pay Transparency Notice</a></reputed company></p> </div> <div style="mso-reputed company: para-border-div; border: none; border-top: solid #C7C7C7 1.0pt; mso-border-top-themecolor: text1; mso-border-top-themetint: 64; mso-border-top-alt: solid #C7C7C7 .25pt; padding: 1.0pt 0in 0in 0in;"> <p style="margin-bottom: 3.0pt; border: none; mso-border-top-alt: solid #C7C7C7 .25pt; mso-border-top-themecolor: text1; mso-border-top-themetint: 64; padding: 0in; mso-padding-alt: 1.0pt 0in 0in 0in;"><br><reputed company style="font-family: Arial;"><reputed company style="reputed company: #232323; font-family: Arial, reputed company; font-size: 8pt;">reputed company is an Equal Opportunity Employer and ensures its employment reputed company </reputed company><reputed company style="reputed company: #232323; font-family: Arial, reputed company; font-size: 8pt;">reputed company with principles embodied in Title VII, the Age Discrimination in </reputed company><reputed company style="reputed company: #232323; font-family: Arial, reputed company; font-size: 8pt;">Employment reputed company, the Rehabilitation reputed company of 1973, the Vietnam Veterans </reputed company><reputed company style="reputed company: #232323; font-family: Arial, reputed company; font-size: 8pt;">Readjustment Assistance reputed company of 1974, Executive Order 11246, Revised Order </reputed company><reputed company style="reputed company: #232323; font-family: Arial, reputed company; font-size: 8pt;">Number 4, and applicable state regulations. <br> </reputed company><reputed company style="reputed company: #232323; font-family: Arial, reputed company; font-size: 5.5pt;">© 2024 reputed company. reputed company rights reserved. The reputed company reputed company, products, </reputed company><reputed company style="reputed company: #232323; font-family: Arial, reputed company; font-size: 5.5pt;">associated trademarks and reputed company are owned by reputed company or relat­ed entities. RV092724TJO</reputed company><reputed company style="font-size: 10pt; font-family: Arial, reputed company;"> </reputed company><br> <br> <a rel="noopener" href="http://www.reputed company.com/" reputed company="_blank"><reputed company style="font-size: 10.0pt; font-family: 'Arial',reputed company;">reputed company.com</reputed company></a><reputed company style="font-size: 10pt; font-family: Arial, reputed company; reputed company: #909090;">    |    </reputed company><a rel="noopener" href="http://reputed company.com/careers" reputed company="_blank"><reputed company style="font-size: 10.0pt; font-family: 'Arial',reputed company;">reputed company Careers</reputed company></a><reputed company style="font-size: 10pt; font-family: Arial, reputed company; reputed company: #909090;">    |    </reputed company><a rel="noopener" href="http://reputed company.com/careers-benefits" reputed company="_blank"><reputed company style="font-size: 10.0pt; font-family: 'Arial',reputed company;">reputed company Benefits & Perks</reputed company></a><reputed company style="font-size: 10pt; font-family: Arial, reputed company; reputed company: #909090;">    </reputed company><reputed company style="font-size: 10pt; font-family: Arial, reputed company; reputed company: #909090;">|    </reputed company><a rel="noopener" href="https://reputed company.com/careers-physical-demands" reputed company="_blank"><reputed company style="font-size: 10.0pt; font-family: 'Arial',reputed company;">Physical Demands</reputed company></a> <br></reputed company></p> </div> </div> </div> </div>