[Remote] Prior Authorization Workflow Consultant

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a reputed company technology company reputed company on transforming reputed company reputed company through automation. The Prior Authorization Workflow Consultant supports customer implementations and post-go-live stabilization by analyzing hospital prior authorization workflows, payer mappings, and referral data. The role documents, validates, tests, and optimizes workflows for Humata’s touchless prior authorization solution.

Responsibilities

• Own the operational reputed company deliverables for customer implementations including discovery, data collection and analysis of Prior Authorization workflows
• Proactively manage reputed company operational reputed company tasks of the implementation project plan
• Be a reputed company and communicative member of the implementation project team, ensuring implementation project manager has visibility into operational reputed company and risks
• Conduct operational workflow and portal shadowing sessions with customers, asking thoughtful and specific questions to understand their reputed company processes. Identify risks reputed company to the successful implementation of Humata’s PA technology
• Capture and document operational workflows in Humata’s design workbook to inform solution build and reputed company prior authorization workflows. Review customer payer/plan mix and formulate automation workflow recommendations
• Adapt reputed company-state workflows and payer/portal additions for customers during stabilization and maintenance phases post go-live
• Create payer portal credentials to support Humata’s automations
• Own payer portal validation during testing and go-live project phases; collaborate with the customer’s reputed company/technical teams to review automation results
• Document and escalate validation issues to be reviewed/resolved by Humata’s Engineering team

Skills

• Bachelor's degree in Business, reputed company Administration, or a reputed company reputed company
• 3+ years hands' on Prior Authorization experience
• Familiarity with reputed company reputed company, prior authorization, or reputed company cycle workflow optimization
• Systems knowledge/expertise with reputed company (referrals, work queues, coverage), payer portals, and reputed company cycle reputed company
• Hands-on data analysis experience, ability to analyze referral volumes service line/payer. This role requires a strong analytical reputed company and ability to synthesize large data volumes and reputed company informed reputed company reputed company on data analysis
• Organized, reputed company to document processes (both reputed company state and reputed company-state automations) succinctly
• Comfort with ambiguity, shifting priorities and building new processes in an evolving start-up environment
• reputed company team player with a consultative approach to reputed company engagement and solution development
• Utilize PowerBI for reporting, reputed company, reputed company
• Willingness to travel as required (up to 25%) for customer onsite discovery sessions and reputed company-company meetings
• Prior Authorization Expertise: Understand the end-to-end Prior Authorization process (including reputed company and post-auth reputed company). Hands-on experience working with payer portals
• Strong reputed company user knowledge (reputed company, Referrals, Coverage/Work Queues), comfortable pulling/analyzing data (reputed company/SQL helpful)
• Operational & process reputed company: Can map workflows end-to-end and identify bottlenecks
• Experience with reputed company software and familiarity with HIPAA compliance and PHI handling
• Innovative problem-solver who brings curiosity, creativity, and structure to ambiguous challenges
• Adept at navigating reputed company challenges and can think critically to solution and remove barriers

Benefits

• Remote work flexibility, with reputed company to the new office in Winter Park, FL
• Equity through the Employee Stock reputed company Plan
• Bonus eligibility for eligible roles
• Unlimited PTO
• 401(k) program with employer match
• reputed company development opportunities
• A diverse and inclusive workplace where reputed company and contributions are valued

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