Prior Authorization Workflow Consultant

🕒 Maio 13

🇺🇸 Estados Unidos – Remoto (EUA)

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

💼 Consultor

👻 Score fantasma 35%

O que significa: a chance de ninguém estar realmente contratando para esta vaga.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Como pontuamos: tempo em aberto, republicações, vagas abertas vs tamanho do time, rapidez para fechar vagas, e se o salário está divulgado.Observação: é uma estimativa de dados públicos, não um julgamento da empresa. Vagas reais podem ter pontuação alta, então use como uma dica, não como um fato.

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Humata Health

SiteLinkedInTodas as Vagas

51 - 200 funcionários

🏥 Saúde

💼 Consultoria

🤖 Inteligência Artificial

Healthcare • Consulting • Artificial Intelligence

A Humata Health é uma empresa liderada por médicos que está revolucionando o processo de autorização prévia na saúde usando tecnologia avançada de inteligência artificial. Sua plataforma automatiza as complexidades envolvidas na autorização prévia, com o objetivo de otimizar os fluxos de trabalho de aprovação para prestadores de serviços de saúde e pagadores, melhorando, assim, o cuidado ao paciente. Ao permitir autorizações sem toque e reduzir os encargos administrativos, a Humata Health procura melhorar a eficiência e reduzir os custos dentro do sistema de saúde.

Descrição

• Own operational workstream deliverables for customer implementations, including discovery, data collection, and analysis of Prior Authorization workflows • Proactively manage operational workstream tasks in the implementation project plan • Collaborate with the implementation project team and provide the implementation project manager visibility into operational progress and risks • Conduct operational workflow and portal shadowing sessions with customers • Ask specific questions to understand current customer processes and identify implementation risks • Capture and document operational workflows in Humata’s design workbook • Inform solution builds and develop prior authorization workflows • Review customer payer/plan mix and formulate automation workflow recommendations • Adapt future-state workflows and payer/portal additions during post-go-live stabilization and maintenance • Create payer portal credentials to support Humata’s automations • Own payer portal validation during testing and go-live phases • Collaborate with customer operations and technical teams to review automation results • Document and escalate validation issues to Humata’s Engineering team

🎯 Requisitos

• Bachelor’s degree in Business, Healthcare Administration, or a related field • 3+ years hands-on Prior Authorization experience • Familiarity with healthcare operations, prior authorization, or revenue cycle workflow optimization • Systems knowledge/expertise with Epic (referrals, work queues, coverage), payer portals, and revenue cycle operations • Hands-on data analysis experience; ability to analyze referral volumes by service line/payer • Strong analytical mindset and ability to synthesize large data volumes and make informed decisions based on data analysis • Ability to document current-state and future-state processes succinctly • Comfort with ambiguity, shifting priorities, and building new processes in an evolving start-up environment • Collaborative team player with a consultative approach to client engagement and solution development • Proficiency with PowerBI, Google Workspace, and Slack • Willingness to travel as required, up to 25%, for customer onsite discovery sessions and all-company meetings • Preferred: End-to-end Prior Authorization expertise, including pre- and post-authorization touchpoints • Preferred: Hands-on experience working with payer portals • Preferred: Strong Epic user knowledge, including Cadence, Referrals, Coverage/Work Queues • Preferred: Ability to pull and analyze data; Excel/SQL helpful • Preferred: Ability to map workflows end-to-end and identify bottlenecks • Preferred: Experience with healthcare software and familiarity with HIPAA compliance and PHI handling • Preferred: Innovative problem-solving, curiosity, creativity, and structure in ambiguous challenges • Preferred: Ability to navigate complex challenges, think critically, develop solutions, and remove barriers • Legally authorized to work in the United States on a full-time basis • Must answer whether employment visa sponsorship is currently or potentially required

🏖️ Benefícios

• Equity through Employee Stock Option Plan • Bonus-eligible role • Full benefits package • Unlimited PTO • 401k program with employer match • Remote flexibility • Access to the new office in Winter Park, FL • Professional development opportunities • Inclusive workplace culture

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