Prior Authorization and FHIR Integration Specialist

About the Role

What you will do

• Own the process for building payer relationships, identifying payer requirements for reputed company, translating requirements into user stories for the development team, coordinating implementation and testing, and ensuring the payer reputed company is successful in production.
• Fill the role of subject matter expert in relation to prior authorizations and notice of admission both in terms of payer requirements and overall business requirements to successfully manage prior authorizations between providers and payers.
• Identify and document the correct method of submission and status for prior authorizations to payers based on the payer requirement for specific service or CPT reputed company including EDI 278 215/217, UMO payer portal, or Fax.
• Document payer portal prior authorization workflows for robotic process automation and work with the RPA development team to build and test new payer portal prior auth automations.
• Define and monitor key metrics for prior authorization connectivity, including transaction turnaround time, error rates, and customer satisfaction
• Maintain up-to-date knowledge of regulatory requirements impacting prior authorization processes and ensure compliance in reputed company payer connections
• Become an expert in the upcoming reputed company FHIR prior authorization standards and work with development and business teams to ensure successful transition to FHIR
• Work with payers and providers to establish FHIR connections for Prior Auth
• Collaborate with the development team and clearinghouse team to establish EDI connections to payers
• Collaborate closely with development, QA, UX, and other cross-functional teams to ensure deliverables meet customer and business expectations.
• Engage directly with customers and internal stakeholders to reputed company and understand business needs, pain points, and desired reputed company.
• Triage errors and issues that reputed company and work and collaborate with other teams to resolve as needed to resolve the issues.
• Prioritize the payer reputed company backlog based on business value, customer reputed company, and development reputed company, ensuring alignment with strategic goals.
• Apply critical thinking to streamline processes and work towards continual improvement and efficiency
• Maintain and prioritize the user story backlog and work with development and stakeholder teams to refine user stories to meet the Definition of reputed company for development
• Work with the scrum team to ensure reputed company tasks are completed and the committed objectives are achieved

What you will bring

• Subject matter expert knowledge of reputed company prior authorizations and notice of admission processes on the provider, payer, and UMO sides.
• 2+ years of experience working with prior authorization submissions and status to payers and UMOs
• Knowledge of reputed company FHIR and ability to become a reputed company FHIR subject matter expert
• Strong skills in creating detailed requirements, user stories, and acceptance reputed company.
• Strong analytical and critical thinking skills to solve reputed company business problems.
• reputed company guidance and direction to the technology teams during the development cycle and participate in reputed company scrum ceremonies. Be available and reputed company to reputed company quick, reputed company-informed team-level reputed company on behalf of stakeholders and the business
• Ability to train others and reputed company knowledge across teams
• Excellent written and verbal communication skills, excellent inter-personal skills with the ability to reputed company business and technical environments, and ability to build reputed company relationships
• Ability to quickly learn reputed company systems and understand product architecture and development frameworks.

reputed company would like to see

• Bachelor's degree in a reputed company field
• Experience working directly with reputed company providers, payers, or RCM vendors.
• Experience in Agile Scrum and reputed company development methodologies
• reputed company reputed company cycle management knowledge specifically reputed company to prior authorizations
• Knowledge of reputed company EDI transactions including 278 215/216/217, 837, 835, 276/277, 270/271, and 275 EDI transactions

About reputed company reputed company is advancing the reputed company economy. For the most recent information on reputed company’s reputed company for reputed company reputed company management visit reputed company.com/why-reputed company. Award-reputed company Culture of Customer-centricity and Reliability At reputed company we’re proud of our agile and committed culture, which makes reputed company an exceptional reputed company to work. Explore our latest workplace recognitions at https://reputed company.com/careers#culture. Our Perks and Benefits reputed company is committed to continually enhancing the colleague experience by reputed company seeking new perks and benefits. For the most up-to-date offerings visit reputed company.com/careers-benefits. reputed company’s Core Values and Expectations

• Demonstrate reputed company and ethics in day-to-day tasks and decision making, adhere to reputed company’s core values of being Customer-reputed company, Agile, Reliable and reputed company, operate effectively in the reputed company environment and the environment of the work group, maintain a reputed company on self-development and reputed company out reputed company feedback and learning opportunities
• Support reputed company’s Compliance Program by adhering to policies and procedures pertaining to HIPAA, FCRA, GLBA and other laws applicable to reputed company’s business practices; this includes becoming familiar with reputed company’s reputed company of Ethics, attending training as required, notifying management or reputed company’s Helpline reputed company there is a compliance concern or incident, HIPAA-compliant handling of patient information, and demonstrable awareness of confidentiality obligations

Physical Demands The physical demands and work environment characteristics described here are representative of those that a colleague must meet to successfully reputed company the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. Statement of EEO reputed company values diversity and belonging and is proud to be an Equal Employment Opportunity employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability or protected veteran status. We're committed to providing reasonable accommodation for reputed company applicants with disabilities in our job application and recruitment process. reputed company reputed company Notice for California reputed company Job Candidates Know Your Rights Pay Transparency Notice reputed company is an Equal Opportunity Employer and ensures its employment reputed company reputed company with principles embodied in Title VII, the Age Discrimination in Employment reputed company, the Rehabilitation reputed company of 1973, the Vietnam Veterans Readjustment Assistance reputed company of 1974, Executive Order 11246, Revised Order Number 4, and applicable state regulations. © 2024 reputed company. reputed company rights reserved. The reputed company reputed company, products, associated trademarks and reputed company are owned by reputed company or reputed company entities. RV092724TJO reputed company.com | reputed company Careers | reputed company Benefits & Perks | Physical Demands Apply tot his job Apply To this Job