Job Details

Oracle Clinical AI Assistant 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)
• 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
• Strong understanding of prior authorization processes, payer guidelines, medical necessity criteria, and regulatory compliance (HIPAA, CMS, ACA, etc.)
• Strong analytical skills with the ability to identify process inefficiencies and design practical solutions.
• 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.)

Disclaimer: Certain US customer or client-facing roles may be required to comply with applicable requirements, such as immunization and occupational health mandates.

Range and benefit information provided in this posting are specific to the stated locations only US: Hiring Range in USD from $29.42 to $60.63 per hour; from: $61,200 to $126,100 per annum. May be eligible for equity. Oracle maintains broad salary ranges for its roles in order to account for variations in knowledge, skills, experience, market conditions and locations, as well as reflect Oracle's differing products, industries and lines of business. Candidates are typically placed into the range based on the preceding factors as well as internal peer equity. Oracle US offers a comprehensive benefits package which includes the following: Medical, dental, and vision insurance, including expert medical opinion; Short term disability and long term disability; Life insurance and AD&D Supplemental life insurance (Employee/Spouse/Child); Health care and dependent care Flexible Spending Accounts; Pre-tax commuter and parking benefits; 401(k) Savings and Investment Plan with company match; Paid time off: Flexible Vacation is provided to all eligible employees assigned to a salaried (non-overtime eligible) position. Accrued Vacation is provided to all other employees eligible for vacation benefits. For employees working at least 35 hours per week, the vacation accrual rate is 13 days annually for the first three years of employment and 18 days annually for subsequent years of employment. Vacation accrual is prorated for employees working between 20 and 34 hours per week. Employees working fewer than 20 hours per week are not eligible for vacation. 11 paid holidays; Paid sick leave: 72 hours of paid sick leave upon date of hire. Refreshes each calendar year. Unused balance will carry over each year up to a maximum cap of 112 hours. Paid parental leave; Adoption assistance; Employee Stock Purchase Plan; Financial planning and group legal; Voluntary benefits including auto, homeowner and pet insurance.