Prior Authorization Workflow Consultant

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Humata Health

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51 - 200 Mitarbeiter

🤖 Künstliche Intelligenz

⚕️ Krankenversicherung

Artificial Intelligence • Healthcare Insurance

Humata Health ist ein unter der Leitung von Ärzten stehendes Unternehmen, das den Prozess der Genehmigungen im Gesundheitswesen mit fortschrittlicher künstlicher Intelligenz revolutioniert. Ihre Plattform automatisiert die Komplexitäten der Genehmigungen, mit dem Ziel, die Genehmigungsabläufe für Gesundheitsdienstleister und Kostenträger effizienter zu gestalten und letztlich die Patientenversorgung zu verbessern. Durch die Einführung von berührungsloser Genehmigung und die Reduzierung des administrativen Aufwands strebt Humata Health an, die Effizienz zu steigern und die Kosten im Gesundheitssystem zu senken.

Beschreibung

• Own the operational workstream deliverables for customer implementations including discovery, data collection and analysis of Prior Authorization workflows. • Proactively manage all operational workstream tasks of the implementation project plan • Be a collaborative and communicative member of the implementation project team, ensuring implementation project manager has visibility into operational progress and risks • Conduct operational workflow and portal shadowing sessions with customers, asking thoughtful and specific questions to understand their current processes. Identify risks related to the successful implementation of Humata’s PA technology. • Capture and document operational workflows in Humata’s design workbook to inform solution build and develop prior authorization workflows. Review customer payer/plan mix and formulate automation workflow recommendations • Adapt future-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 operations/technical teams to review automation results • Document and escalate validation issues to be reviewed/resolved by Humata’s Engineering team

🎯 Anforderungen

• 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 service line/payer. This role requires a strong analytical mindset and ability to synthesize large data volumes and make informed decisions based on data analysis • Organized, able to document processes (both current state and future-state automations) 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 • Utilize PowerBI for reporting, Google Workspace, Slack • Willingness to travel as required (up to 25%) for customer onsite discovery sessions and all-company meetings

🏖️ Vorteile

• Impactful Work: Contribute to innovative solutions that improve healthcare efficiency and patient outcomes • Remote Flexibility: Enjoy working remotely while being part of a collaborative team, with access to our new office in Winter Park, FL • Competitive Compensation: Enjoy competitive base compensation, equity through our Employee Stock Option Plan, and bonus-eligible roles • Comprehensive Benefits: Full benefits package including unlimited PTO and 401k program with employer match • Growth Opportunities: Advance your career in a fast-paced, high-impact environment with ample professional development • Inclusive Culture: Join a diverse workplace where your ideas and contributions are valued