Prior Authorization Workflow Consultant

Summary

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

Qualifications

Must Haves

• 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

Nice to Haves

• 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

• Enjoy working remotely while being part of a collaborative team, with access to our new office in Winter Park, FL
• Equity through our Employee Stock Option Plan
• Bonus-eligible role
• Unlimited PTO
• 401k program with employer match
• Ample professional development
• Join a diverse workplace where your ideas and contributions are valued