Prior Authorization Workflow Consultant

Job 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