Note: The job is a remote job and is open to candidates in USA. Humata Health is a healthcare technology company focused on transforming healthcare operations 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 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
Skills
- 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
- Prior Authorization Expertise: Understand the end-to-end Prior Authorization process (including pre and post-auth touchpoints). Hands-on experience working with payer portals
- Strong Epic user knowledge (Cadence, Referrals, Coverage/Work Queues), comfortable pulling/analyzing data (Excel/SQL helpful)
- Operational & process mindset: Can map workflows end-to-end and identify bottlenecks
- Experience with healthcare software and familiarity with HIPAA compliance and PHI handling
- Innovative problem-solver who brings curiosity, creativity, and structure to ambiguous challenges
- Adept at navigating complex challenges and can think critically to solution and remove barriers
Benefits
- Remote work flexibility, with access to the new office in Winter Park, FL
- Equity through the Employee Stock Option Plan
- Bonus eligibility for eligible roles
- Unlimited PTO
- 401(k) program with employer match
- Professional development opportunities
- A diverse and inclusive workplace where ideas and contributions are valued
Company Overview