Prior Authorization Workflow Consultant

Prior Authorization Workflow Consultant

The Prior Authorization Workflow Consultant plays a critical role in Humata Health's customer's implementation process and post go-live stabilization/maintenance efforts. This role sits at the intersection of hospital operations, Epic workflows, and payer portal automation. The PA Workflow Consultant partners with hospital PA staff to review prior authorization workflows, referral volumes, and payer mappings, ensuring seamless alignment with Humata's automation platform. They will validate existing automations, document requirements for new ones, and ensure workflows are fully mapped, tested, and optimized for Humata's touchless prior authorization solution.

Location: Remote, US or Hybrid - Orlando, Florida, US

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

Role 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 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

Preferred Experience & Skills:

• 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

Why Join Humata Health?

• Impactful Work: Contribute to innovative solutions that improve healthcare efficiency and patient outcomes
• Remote Flexibility: Enjoy working remotely while being part of a collaborative team, with access to our new office in Winter Park, FL
• Competitive Compensation: Enjoy competitive base compensation, equity through our Employee Stock Option Plan, and bonus-eligible roles
• Comprehensive Benefits: Full benefits package including unlimited PTO and 401k program with employer match
• Growth Opportunities: Advance your career in a fast-paced, high-impact environment with ample professional development
• Inclusive Culture: Join a diverse workplace where your ideas and contributions are valued

Humata Health is proud to be an equal-opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, age, sex, marital status, ancestry, neurotype, physical or mental disability, veteran status, gender identity, sexual orientation or any other category protected by law.

Join us in our mission to transform healthcare while building a life that works in harmony both in and outside the office.