Prior Authorization and FHIR Integration Specialist

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

What we would like to see

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 .

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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

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.

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