Prior Authorization Workflow Consultant

About the role

The serves as a critical operational link between hospital teams, Epic systems, and payer automation. This role owns the detailed analysis and optimization of prior authorization workflows to ensure they align with Humata's touchless platform capabilities. You will act as a hands-on expert reviewing current state processes, identifying gaps, and documenting future-state workflows that drive efficiency. The position requires close collaboration with hospital prior authorization staff to validate existing automations and uncover opportunities for improvement. You will ensure that referral volumes, payer mappings, and portal interactions are clearly defined and tested. This role is fundamental to successful customer implementation and long-term stabilization after go-live. Every recommendation you make directly impacts the speed and reliability of automated prior authorization outcomes.

Key facts

What you'll do

Conduct in-depth discovery sessions with hospital clients to collect detailed information about current prior authorization workflows.

Analyze historical referral volumes, service line data, and payer interactions to identify trends and automation opportunities.

Review existing prior authorization workflows within the Epic environment, focusing on referrals, work queues, and coverage checks.

Perform portal shadowing sessions with client staff to observe real-world usage of payer portals and capture nuanced process details.

Document all findings, current state workflows, and future state requirements within Humata's standardized design workbooks.

Evaluate payer mappings and propose adjustments to ensure accurate data transfer between hospital systems and payer portals.

Validate the configuration of automated workflows within the Humata platform against client requirements and observed realities.

Create and manage payer portal credentials necessary to support automation testing and ongoing validation activities.

Own the validation phase of testing, comparing automation results against expected outcomes and documenting any discrepancies.

Collaborate closely with the implementation project manager to provide transparent updates on operational progress and emerging risks.

Document validation issues in detail and escalate them to Humata's Engineering team for review, root cause analysis, and remediation.

Adapt future-state workflow designs during the stabilization and maintenance phases to accommodate new payer portals or regulatory changes.

Support the optimization of referral processes by identifying manual steps that can be removed or automated within the Humata platform.

Act as a subject matter expert for hospital teams, answering questions related to workflow logic, data requirements, and system interactions.

Ensure all workflow documentation is clear, concise, and accessible to both technical and non-technical stakeholders.

Requirements

Hold a Bachelor's degree in Business, Healthcare Administration, or a closely related field.

Bring a minimum of 3 years of hands-on Prior Authorization experience within a healthcare setting.

Demonstrate familiarity with healthcare operations, prior authorization life cycles, and revenue cycle workflow optimization.

Show systems knowledge and expertise with Epic modules such as Cadence, Referrals, and Coverage/Work Queues.

Possess hands-on data analysis experience, specifically the ability to analyze referral volumes by service line and payer.

Be highly organized with the ability to document both current state and future-state processes succinctly and accurately.

Exhibit comfort with ambiguity, shifting project priorities, and building new processes in a fast-paced start-up environment.

Function effectively as a collaborative team player, using a consultative approach during client engagements and solution development.

Proficiently utilize tools such as PowerBI for reporting, Google Workspace, and Slack for communication and project management.

Be willing to travel as required, potentially up to 25%, for on-site discovery sessions and company-wide meetings.

Possess strong analytical skills to synthesize large volumes of data and translate them into actionable workflow recommendations.

Understand the importance of process rigor and the need for clear documentation throughout the implementation lifecycle.

Demonstrate the ability to manage multiple workstreams simultaneously while maintaining attention to detail.

Show commitment to aligning hospital operations with technology solutions to achieve optimal automation outcomes.

Nice to have

Deep Prior Authorization Expertise, including a thorough understanding of pre and post-authentication touchpoints and nuances.

Strong Epic user knowledge, particularly around Cadence, Referrals, and Coverage/Work Queues, with the ability to pull and analyze data.

An operational and process-oriented mindset capable of mapping end-to-end workflows and pinpointing bottlenecks.

Direct experience with healthcare software platforms and a solid understanding of HIPAA compliance and PHI handling procedures.

A background as an innovative problem-solver who brings curiosity, creativity, and structured thinking to ambiguous challenges.

Proven ability to navigate complex operational challenges and critically evaluate solutions to remove implementation barriers.

Experience working directly within payer portals and understanding the intricacies of payer rules and configurations.

Familiarity with best practices for testing and validating automated workflows in a clinical operations context.

Practical notes

Willingness to travel is required, with potential travel up to 25% for client onsite visits.

All-company meetings may require travel to the Winter Park, Florida office depending on team schedules.

This role operates on a full-time schedule with standard business hour expectations for collaboration.