About the Role What you will do Own the process for building payer relationships, identifying payer requirements for connection, translating requirements into user stories for the development team, coordinating implementation and testing, and ensuring the payer connection 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 code 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 all payer connections Become an expert in the upcoming Da Vinci 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 elicit and understand business needs, pain points, and desired outcomes. Triage errors and issues that arise and work and collaborate with other teams to resolve as needed to resolve the issues. Prioritize the payer connection backlog based on business value, customer impact, and development capacity, 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 Ready for development Work with the scrum team to ensure all tasks are completed and the committed objectives are achieved What you will bring Subject matter expert knowledge of healthcare 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 Da Vinci FHIR and ability to become a Da Vinci FHIR subject matter expert Strong skills in creating detailed requirements, user stories, and acceptance criteria. Strong analytical and critical thinking skills to solve complex business problems. Provide guidance and direction to the technology teams during the development cycle and participate in all scrum ceremonies. Be available and ready to make quick, well-informed team-level decisions on behalf of stakeholders and the business Ability to train others and share knowledge across teams Excellent written and verbal communication skills, excellent inter-personal skills with the ability to bridge business and technical environments, and ability to build professional relationships Ability to quickly learn complex systems and understand product architecture and development frameworks. What we would like to see Bachelor's degree in a related field Experience working directly with healthcare providers, payers, or RCM vendors. Experience in Agile Scrum and SAFe development methodologies Healthcare revenue cycle management knowledge specifically related to prior authorizations Knowledge of healthcare EDI transactions including 278 215/216/217, 837, 835, 276/277, 270/271, and 275 EDI transactions About FinThrive FinThrive is advancing the healthcare economy. For the most recent information on FinThrive's vision for healthcare revenue management visit finthrive.com/why-finthrive . Award-winning Culture of Customer-centricity and Reliability At FinThrive we're proud of our agile and committed culture, which makes FinThrive an exceptional place to work. Explore our latest workplace recognitions at https://finthrive.com/careers#culture . Our Perks and Benefits FinThrive is committed to continually enhancing the colleague experience by actively seeking new perks and benefits. For the most up-to-date offerings visit finthrive.com/careers-benefits . FinThrive's Core Values and Expectations Demonstrate integrity and ethics in day-to-day tasks and decision making, adhere to FinThrive's core values of being Customer-Centric, Agile, Reliable and Engaged, operate effectively in the FinThrive environment and the environment of the work group, maintain a focus on self-development and seek out continuous feedback and learning opportunities Support FinThrive's Compliance Program by adhering to policies and procedures pertaining to HIPAA, FCRA, GLBA and other laws applicable to FinThrive's business practices; this includes becoming familiar with FinThrive's Code of Ethics, attending training as required, notifying management or FinThrive's Helpline when 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 perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Statement of EEO FinThrive values diversity and belonging and is proud to be an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. We're committed to providing reasonable accommodation for qualified applicants with disabilities in our job application and recruitment process. FinThrive Privacy Notice for California Resident Job Candidates Know Your Rights Pay Transparency Notice FinThrive is an Equal Opportunity Employer and ensures its employment decisions comply with principles embodied in Title VII, the Age Discrimination in Employment Act, the Rehabilitation Act of 1973, the Vietnam Veterans Readjustment Assistance Act of 1974, Executive Order 11246, Revised Order Number 4, and applicable state regulations. 2024 FinThrive. All rights reserved. The FinThrive name, products, associated trademarks and logos are owned by FinThrive or related entities. RV092724TJO finthrive.com | FinThrive Careers | FinThrive Benefits
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