Prior Authorization Workflow Consultant

🕒 May 13

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 Ghost score 45%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Humata Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

💼 Consulting

🤖 Artificial Intelligence

Healthcare • Consulting • Artificial Intelligence

Humata Health is a physician-led, AI company dedicated to creating a frictionless prior authorization process for healthcare providers, payers, and patients. The company focuses on automating and optimizing operational workflows to enhance revenue cycle management, reduce errors, and ensure patients receive timely care. By leveraging advanced artificial intelligence, Humata Health aims for efficient submission of authorizations and improved patient transparency. With a strong emphasis on collaboration with strategic partners and maintaining high efficiency in authorization handling, Humata Health has successfully automated a significant portion of referral volumes, transforming the healthcare system.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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