Role: Business Analyst/Project Manager
Bill Rate: $81/hour C2C
Location: Remote
Duration: 12+ months/ long-term
Interview Criteria: F2F
Direct Client Requirement
Key Responsibilities:Act as a subject matter expert (SME) in pre-authorization workflows, covering medical necessity, clinical documentation, prior authorization rules, and payer–provider interactions.
Support clients in transforming pre-auth processes to improve speed, compliance, and patient experience.
Analyze existing business processes, identify gaps, and design target operating models for pre-auth.
Partner with technology teams to shape digital and GenAI solutions (e.g., automated prior authorization, real-time benefit checks, interoperability with EMR/EHR).
Advise on compliance with CMS, FDA, and global regulations around pre-authorization, patient safety, and access.
Collaborate with product managers, architects, and delivery teams to ensure business requirements are translated into solution designs.
Conduct workshops with client stakeholders to gather business requirements, define KPIs, and build consensus.
Contribute to thought leadership (white papers, PoVs, webinars) on pre-auth trends and innovation in life sciences.
Required Skills & Experience:7–12 years of domain experience in Life Sciences, Healthcare, or Payer/Provider organizations, with at least 3–5 years focused on pre-authorization or utilization management.
Strong knowledge of:
Prior authorization workflows (medical and pharmacy benefits)
Interoperability standards (HL7 FHIR, X12, NCPDP)
Clinical guidelines and evidence-based medical policy
Patient access and affordability challenges
Exposure to payer and provider systems (EHR, claim processing, benefit management).
Experience in consulting or business analysis roles, preferably with global clients.
Proven ability to liaise between business and technology teams.
Excellent communication, presentation, and stakeholder management skills.
Preferred QualificationsExperience with CMS interoperability mandates (e.g., CMS-0057-F, PA APIs).
Knowledge of life sciences value chain (pharma/biotech market access, hub services, patient support programs).
Familiarity with AI/ML and automation use cases in pre-auth and utilization management.
Prior experience in a consulting firm or digital transformation environment.
Bachelor’s or Master’s degree in Life Sciences, Healthcare Management, Pharmacy, or related field; MBA preferred.
NOTE: Thank you for visiting our jobs page. Please submit your application using the Apply Now link. Our recruitment team is currently reviewing all applications thoroughly. We will be in touch with candidates who are shortlisted for the next stage of the interview process.
Valiant Technologies LLC
166 Geary St
San Francisco, CA 94108
Phone: (415) 935-9966
srinivasa.kandi@valianttec.com
Tags: Srinivasa Reddy Kandi, #SrinivasaReddyKandi, @SrinivasaReddyKandi, Srinivasa Kandi, #SrinivasaKandi, @SrinivasaKandi, Kandi Srinivasa Reddy, #KandiSrinivasaReddy, @KandiSrinivasaReddy
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