The Radiology Authorization Specialist reports to the Radiology Authorization Supervisor. The Radiology Authorization Specialist is responsible for obtaining appropriate prior authorizations for radiology (imaging) exams ordered by Dana-Farber Cancer Institute (DFCI) Providers.
The Radiology Authorization Specialist will leverage his/her strong medical terminology and physiology knowledge to select appropriate clinical documents during the insurance authorization process. To ensure authorizations are appropriately in place, the Radiology Authorization Specialist will successfully coordinate the work of various groups, including, but not limited to: physicians, mid-level practitioners, clinical support specialists, third party payers, fellow patient access and revenue cycle teams and/or other prior authorization team members.
Located in Boston and the surrounding communities, Dana-Farber Cancer Institute brings together world renowned clinicians, innovative researchers and dedicated professionals, allies in the common mission of conquering cancer, HIV/AIDS and related diseases. Combining extremely talented people with the best technologies in a genuinely positive environment, we provide compassionate and comprehensive care to patients of all ages; we conduct research that advances treatment; we educate tomorrow's physician/researchers; we reach out to underserved members of our community; and we work with amazing partners, including other Harvard Medical School-affiliated hospitals.
Review and monitor all radiology authorization workqueues, identifying imaging exams.
Independently identified all patient access issues creating barriers to prior authorization workflows. Coordinates the resolution of patient access issues with appropriate teams, and when necessary, resolves issues independently.
Prepare and complete payer-specific prior authorization requests, interpret medical policy criteria, and apply appropriate guidelines to prior authorization requests.
Review and comprehend patient progress notes, lab reports, infusion summaries, imaging reports, and plan of care. Identify appropriate medical documentation that satisfies payer medical policy criteria.
Determine when documentation does not meet medical policy guidelines and coordinate appropriate follow-up by clinical staff members that aid in the prior authorization process (e.g. prior authorization nurse review, physician peer-to-peers, and/or letters of medical necessity).
Follow-up with appropriate parties to meet all deadlines and prevent prior authorization denials.
Manage prior authorization process from initial submission to authorization for all assigned cases.
Monitor and report changes in payer prior authorization requirements.
Maintain detailed filing and archiving of prior authorizations to support post-claim denial workflows.
Update and maintain prior authorization tools and spreadsheets.
Assists in the orientation and training of new staff.
Completes assigned work, projects, and other duties as assigned.
MINIMUM JOB QUALIFICATIONS:
Bachelor's degree preferred.
1-3 years equivalent work experience required. Experiences include, but are not limited to: healthcare/business administration, health insurance, medical policy/chart review, nursing, and/or other allied health fields. Appropriate science and healthcare graduate course work can be substituted.
Performs primary duties independently and progresses toward performing more advanced tasks, as directed.
Superior knowledge of outpatient hospital revenue cycle workflows and systems
Excellent organizational skills – must be detail-oriented, independently prioritize workload, and manage time.
Excellent communication skills – effectively interacts with all levels of staff and external contacts.
Superior technical skills with experience with Microsoft Office. Epic experience strongly preferred.
KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:
Expert analytical and problem solving skills
Prioritizes work independently to meet all deadlines
Independently coordinates colleagues and clinicians to complete required tasks related to insurance authorizations
Provides expert customer service and excellent communication skills - especially written
Must be able to effectively multi-task and have advanced technical skills
Dana-Farber Cancer Institute is an equal opportunity employer and affirms the right of every qualified applicant to receive consideration for employment without regard to race, color, religion, sex, gender identity or expression, national origin, sexual orientation, genetic information, disability, age, ancestry, military service, protected veteran status, or other groups as protected by law.
Internal Number: 2020-20561
About Dana-Farber Cancer Institute
Located in Boston and the surrounding communities, Dana-Farber Cancer Institute brings together world renowned clinicians, innovative researchers and dedicated professionals, allies in the common mission of conquering cancer, HIV/AIDS and related diseases. Combining extremely talented people with the best technologies in a genuinely positive environment, we provide compassionate and comprehensive care to patients of all ages; we conduct research that advances treatment; we educate tomorrow's physician/researchers; we reach out to under-served members of our community; and we work with amazing partners, including other Harvard Medical School-affiliated hospitals.