Prior Authorization Manager/Subject Matter Expert

Prior Authorization Manager/Subject Matter Expert

Location: Part-Time, Remote
Job Type: Contract (3-9 Months)

Company Overview
Mizzeto is a healthcare IT solutions firm dedicated to automating payer operations through innovative technology.

We are currently seeking an experienced Prior Authorization Manager/Subject Matter Expert (SME) to join our team. This is an exciting opportunity to work with cutting-edge healthcare technologies while making a significant impact on healthcare operations. If you have extensive experience with Prior Authorization processes and QNXT, and you’re passionate about delivering innovative solutions, we want to hear from you!

Job Summary

As a Prior Authorization Manager/SME, you will serve as a subject matter expert for prior authorization in our utilization management department. Provide in-depth expertise, support, and guidance on best practices, system integration, and operational efficiencies. Your focus will be process improvement using automation. You will be responsible for working closely with both internal teams and clients to optimize the use of QNXT/other UM tools & enhance efficiency by identifying areas to automate.

In this role, you will leverage your expertise to troubleshoot complex issues, streamline prior authorization workflows, ensure compliance with regulations, and provide training and knowledge transfer to internal teams and clients.

Key Responsibilities:

• Prior Authorization Expertise: Provide subject matter expertise on prior authorization processes, workflows, and guidelines. Ensure that prior authorization processes are compliant with healthcare regulations, including HIPAA, CMS, and other relevant standards.
• QNXT Expertise: Leverage your extensive experience with the QNXT platform to support clients in configuring, implementing, and troubleshooting prior authorization processes and related workflows.
• Utilization Management: Support the alignment of prior authorization with utilization management processes to ensure efficient and compliant operations.
• Process Optimization: Collaborate with cross-functional teams to improve prior authorization workflows and work closely with technology team to identify opportunities to automate and increase efficiency.
• Client Support & Training/Documentation: Act as the primary point of contact for clients needing assistance with QNXT/other UM platform prior authorization issues, processes and system enhancements. You should also be able to develop training materials and documentation to support both internal teams and clients, and best practices related to prior authorization and utilization management.
• Problem Resolution & Continuous Improvement: Identify and resolve complex system issues, escalation points, and challenges related to prior authorization processes. You must also stay updated on the latest healthcare trends, technologies, and regulations to provide insights and recommendations for continuous process improvement.

Qualifications:

• Minimum of 5 years of experience working in healthcare IT, with a focus on prior authorization and utilization management.
• Extensive experience with QNXT (UM Module), workflow management, and troubleshooting.
• Strong understanding of utilization management processes, prior authorization protocols, and healthcare payer operations.
• Knowledge of regulatory compliance requirements (e.g., HIPAA, CMS guidelines, and other relevant standards).
• Excellent problem-solving skills with the ability to troubleshoot complex issues.
• Strong verbal and written communication skills, including the ability to convey complex information to non-technical stakeholders.
• Proven ability to manage multiple priorities in a fast-paced setting, both working independently and, in a team-oriented environment as well.

Education:

Bachelor’s degree in Healthcare Administration, Information Technology, or a related field. Relevant work experience may substitute for formal education.

Preferred Experience

• Experience in healthcare payer operations or with healthcare payer platforms.
• Prior experience with other healthcare management platforms (in addition to QNXT) is a plus.
• Familiarity with industry trends, regulatory changes, and technological innovations in healthcare IT.

If you are an experienced Prior Authorization SME with deep knowledge of QNXT and a passion for improving healthcare processes, we’d love to hear from you! Apply today and join a forward-thinking company that values your expertise and commitment to transforming the healthcare industry.

Job Types: Part-time, Contract
Contract length: 6 months