Prior Authorization Workflow Consultant

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

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