Prior Authorization Advisor

Company DescriptionBlue Ocean Interventional is a pioneering organization dedicated to delivering innovative healthcare solutions that transform patient care and outcomes. Blue Ocean Interventional collaborates with healthcare providers to streamline processes and enhance efficiency. By prioritizing patient-centered approaches, the company aims to redefine healthcare excellence in its field.ResponsibilitiesWe are seeking a full-time, remote Prior Authorization advisor/specialist. The role involves managing and coordinating prior authorization processes to ensure timely approvals for medical procedures and treatments. Responsibilities include reviewing clinical documentation, liaising with insurance payers, analyzing payer policies, and determining best course of action for adverse outcomes of requests. The Prior Authorization advisor/specialist will teach clinics how to optimize patient care by reducing delays and enhancing procedural efficiency.QualificationsCore ExperienceExperience with prior authorization, insurance authorization, or utilization managementFamiliarity with prior authorization workflows, appeals, and peer-to-peer reviewsExperience analyzing denials and identifying corrective actionsBackground in revenue cycle or client-facing healthcare support rolesClinical & Regulatory KnowledgeWorking knowledge of medical terminology, compliance requirements, and payer guidelinesAbility to review clinical documentation and apply medical policy criteriaSkills & CompetenciesStrong organizational skills, attention to detail, and time managementAbility to identify and resolve authorization issues or discrepanciesEffective written and verbal communication skillsAbility to collaborate with insurance carriers, providers, billing teams, and clinical staffComfortable working independently in a remote environmentCollaborative team playerDocumentation & TrainingAbility to create job aids, document processes, and train othersExperience writing clinical audiencesMicrosoft proficiencyEducation and/or Preferred ExperienceDegree in Healthcare Information Technology, Revenue Cycle Management, or related field preferred or commensurate clinical experienceUrology experience a plus