Prior Authorization Product Analyst

Oracle Clinical AI Assistant (CAA) enables providers to demonstrate the power of generative AI together with voice commands to reduce manual documentation and clinical tasks, so they can focus more attention on patient care.

Our diverse team of creators and inventors are building the future of conversational clinical interfaces, making real improvements in the lives of people across the world. We act with the speed and attitude of a start-up, but with the scale and customer focus of the world’s leading enterprise software company. We have a big charter and a lot of creative freedom to get it done. Come join us and grow your career in this exciting arena.

We are looking for a Prior Authorization Product Analyst to drive the features and capabilities of the prior authorization aspect of the CAA. As part of the Oracle Health AI Product Management team, you will contribute to products geared toward physician efficiency and clinical assistance. This role is critical to alleviating burnout for healthcare workers and improving patient experiences.

Qualifications:

This role requires healthcare domain knowledge and will work with cross-functional teams to create a product and ensure the system delivers accurate, compliant, and scalable automation for providers, payers, and patients.

Required Skills & Qualifications:

• Associate’s or Bachelor's Degree or equivalent experience :
  • Healthcare Administration
  • Nursing
  • Health Information Management
  • Public Health
  • Business (with healthcare focus)
• Experience : Minimum of 3+ years in healthcare operations, specifically in prior authorization management in a hospital or physician practice.
  • Direct experience with:
    • Managing prior authorization requests end-to-end
    • Communicating with insurance companies and clinical staff
    • Navigating denials and appeals
• Industry Knowledge : Strong understanding of prior authorization processes, payer guidelines, medical necessity criteria, and regulatory compliance (HIPAA, CMS, ACA, etc.).
• Problem-Solving Skills : Strong analytical skills with the ability to identify process inefficiencies and design practical solutions.
• Communication Skills : Excellent verbal and written communication skills. Ability to explain complex technical concepts to non-technical stakeholders and collaborate effectively with cross-functional teams.

Preferred Qualifications

• One or more of the following certifications:
  • Certified Prior Authorization Specialist (CPAS)
  • Certified Professional Coder (CPC)
  • Certified Medical Administrative Assistant (CMAA)
  • Certified Revenue Cycle Representative (CRCR)
  • Certified Healthcare Access Associate (CHAA)
  • Registered Health Information Technician (RHIT)
  • Medical Billing and Coding Certification

Responsibilities:

• Act as subject matter expert (SME): Provide expertise for prior authorization workflows, payer requirements, and clinical/administrative use cases to identify inefficiencies, bottlenecks, and opportunities for automation. Work closely with technical teams as the knowledge lead for prior authorization processes. Serve as the SME on prior authorization inputs and outputs.
• Cross-functional Collaboration : Work with product, engineering, and applied science teams to ensure alignment with medical necessity guidelines, payer policies, and clinical protocols. Provide input and expertise into the automation strategy for the prior authorization product, ensuring alignment with organizational goals and industry standards and guidelines.
• Regulatory Compliance : Stay current with regulatory requirements related to prior authorization, ensuring that workflows meet all necessary compliance standards (HIPAA, CMS, etc.).