Job Description
I am a software engineer building a tool to help mid-sized medical practices manage prior authorizations. I am looking for a subject matter expert to help me understand the end-to-end workflow during a 1-2 hour consultation call. I am not looking for someone to do data entry. I need a consultant who can share their screen and explain the logic behind the process. During the call, I need you to walk me through two specific scenarios:
The Happy Path: Show me a standard submission where the clinicals are clean, the portal works, and the submission is straightforward.
I need to establish a baseline for how it should look. The Complex Path: Show me a workflow involving Medical Necessity requirements (like for an MRI or surgery). I need to see how you find the specific policy on the payer portal, how you compare it to the doctor's notes, and what you do when the documentation is missing or insufficient. To apply, you must have experience with direct payer portals (like UHC, Anthem, etc.) and understand how to interpret clinical medical policies. Apply tot his job