Prior Authorization Workflow Analyst
Humata Health
full-time
Posted on:
Location: Florida • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
Tech Stack
SQL
About the role
- 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; ask thoughtful and specific questions to understand current processes and identify risks to successful implementation.
- 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 customer operations/technical teams to review automation results.
- Document and escalate validation issues to be reviewed/resolved by 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; Excel/SQL helpful
- 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
- Experience with healthcare software and familiarity with HIPAA compliance and PHI handling
- Prior Authorization Expertise: Understand the end-to-end Prior Authorization process (including pre and post-auth touchpoints). Hands-on experience working with payer portals.