Humata Health, Inc

Compensation

Full Description

🔍 What we're looking for: Humata Health is seeking an Intake Solutions Specialist who supports the clinical, technical, and provider teams by receiving, reviewing, and accurately processing prior authorization (PA) requests for medical and pharmacy services. The role ensures requests are entered and routed efficiently for clinical review, while maintaining compliance with all organizational, state, and federal requirements. The Intake Solutions Specialist provides excellent customer service to providers, internal, and external departments and maintains accuracy and timeliness across all workflows. 📍Location: Remote, US or Hybrid - Orlando, Florida, US ✅ Responsibilities Receive and process incoming prior authorization requests via fax, email, phone, and electronic portals Verify member eligibility, benefit coverage, and provider participation using the payer’s claims and eligibility systems. Confirm whether services require prior authorization based on plan guidelines and benefit plans. Enter authorization requests accurately into the Utilization Management system and apply routing rules. Review requests for completeness; identify missing clinical or demographic information. Contact providers’ offices to obtain missing details or supporting documentation (e.g., physician notes, test results) or troubleshoot issues with submissions. Monitor and track cases to ensure compliance with state, federal, and NCQA turnaround standards. Maintain confidentiality and ensure HIPAA compliance for all protected health information (PHI). Assist in reporting, auditing, and quality improvement activities related to the prior authorization workflow. Support both medical and pharmacy authorization workflows when needed. 🛠 Role Requirements Associate’s degree or healthcare administration coursework preferred but will consider a high school diploma with required experience. 2–5 years of experience in a healthcare, insurance, or utilization management environment. Knowledge of medical terminology and healthcare coding (ICD-10, CPT, HCPCS). Understanding prior authorization, referral, and medical necessity processes. Ability to work in a fast-paced, high-volume environment while maintaining accuracy. Excellent verbal and written communication skills. Strong customer service and organizational skills. Technical Skills Experience with UM or care management platforms. Electronic Prior Authorization Portals: Familiarity with provider-facing portals and submission types Strong working knowledge of the Google suite, Slack, Confluence, Smartsheets, Excel, etc. for documentation, communication, and reporting. Document Management Systems: Experience scanning, uploading, and indexing clinical documentation in shared systems. Telecommunication Systems: Ability to use call center or ticketing software for handling provider inquiries. Data Entry Accuracy: Demonstrated ability to maintain high accuracy and speed while entering detailed information. Basic Reporting Skills: Ability to track and update case status in real time and assist with productivity and compliance reports. You’ll be successful in this role if you have: Prior experience working for a health insurance payer, managed care organization (MCO), or utilization management vendor. Familiarity with state and federal regulations and NCQA accreditation standards preferred. Prior call center or intake coordination experience in a healthcare setting. 🚀 Why Join Humata Health? Impactful Work: Contribute to innovative solutions that improve healthcare efficiency and patient outcomes Remote Flexibility: Enjoy working remotely while being part of a collaborative team, with access to our new office in Winter Park, FL Competitive Compensation: Enjoy competitive base compensation, equity through our Employee Stock Option Plan, and bonus-eligible roles Comprehensive Benefits: Full benefits package including unlimited PTO and 401k program with employer match Growth Opportunities: Advance your career in a fast-paced, high-impact environment with ample professional development Inclusive Culture: Join a diverse workplace where your ideas and contributions are valued - Pay Transparency Humata Health will provide pay transparency information upon application to those in qualifying jurisdictions. Our salary ranges are based on competitive pay for our company’s size and industry. They are one part of the total compensation package that may also include equity, variable compensation, and benefits. Individual pay decisions are ultimately based on several factors, including qualifications, experience level, skillset, geography, and balancing internal equity. - Humata Health is proud to be an equal-opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, age, sex, marital status, ancestry, neurotype, physical or mental disability, veteran status, gender identity, sexual orientation or any other category protected by law. - Join us in our mission to transform healthcare while building a life that works in harmony both in and outside the office.