Job Description
Senior Healthcare Functional Consultant
Domain: Healthcare Provider
Preferred Industry Experience: Oncology / Specialty Care
Location: Remote
Role Summary
We are looking for a Healthcare Functional Consultant with strong experience in patient access and authorization workflows within provider-side healthcare environments.
The role will focus on understanding business processes across Prior Authorization, Eligibility & Benefits Verification, and Financial Clearance, and translating them into structured functional requirements and workflow designs.
The ideal candidate should be comfortable working with cross-functional teams and supporting solution design, implementation, and testing.
Experience in an oncology provider environment is preferred, not mandatory, including familiarity with workflows supporting chemotherapy, procedures, radiology, infusion, treatment readiness, and reimbursement coordination.
Key Responsibilities
• Gather and document business and functional requirements across patient access workflows
• Define current-state and future-state workflows, including process steps, decision points, and exceptions
• Translate business needs into:
o Functional requirements
o User stories
o Process flows
o Acceptance criteria
• Support solution design across:
o Prior Authorization
o Eligibility & Benefits Verification
o Financial Clearance
• Identify process gaps, inefficiencies, and handoff issues
• Work closely with business, operations, product, and technology teams
• Support UAT, defect validation, and requirement traceability
• Maintain structured and clear functional documentation
Required Skills
• Strong understanding of patient access workflows in provider-side healthcare
• Hands-on experience in at least 2 of the following areas:
o Prior Authorization
o Eligibility & Benefits Verification
o Financial Clearance
• Strong skills in:
o Requirements gathering
o Workflow analysis
o Process mapping
• Ability to translate business needs into clear functional documentation
• Strong communication and stakeholder management skills
• Ability to work with both business users and technical teams
Good to Have (Not Mandatory)
• Exposure to:
o Revenue Cycle Management (RCM) downstream processes
• Understanding of:
o Payer-driven workflows
o US healthcare reimbursement models
• Experience with:
o Case management or workflow platforms
o Salesforce or similar systems
• Experience working in Agile environments
• Exposure to specialty care or oncology workflows
Experience Required
• 7+ years of experience in:
o Healthcare operations
o Functional consulting
o Business analysis
• Experience in provider-side US healthcare environment preferred
Education
• Bachelor’s degree in any discipline
• Degrees in Healthcare Administration, Life Sciences, or related fields are preferred but not mandatory
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