• Clinical Prior Authorization Specialist

    Location US-MA-Brookline
    Job Posted Date 4 weeks ago(9/20/2019 8:42 AM)
    Job ID
    2019-14758
    Category
    Finance/Accounting/Patient Billing
    Type
    full time
    Grade
    22
  • Overview

    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.

    The Prior Authorization Nurse Specialist will work within the Revenue Integrity & Billing Compliance team to bring additional clinical expertise to the prior authorization and appeals processes. The Nurse Specialist will be the clinical support person for high cost drug authorizations and off-label chemotherapy authorizations as well as have primary responsibility for appealing rejected claims to payers. The Nurse Specialist will serve as a liaison and patient advocate between the Dana-Farber and health insurance company representatives. This role requires a detail-oriented person who can manage multiple efforts to completion with minimal oversight.


    Responsibilities

    • Submit clinical documentation for authorization of various high cost pharmaceuticals, radiopharmaceuticals, and off-label chemotherapy regimens. 
    • Collaborate as part of an inter-disciplinary team related to the previously mentioned processes. 
    • Serve as a clinical resource to the Revenue Integrity & Billing Compliance team.
    • Collaborate with the Prior Authorization Manager to review and appeal rejected claims in a timely fashion.
    • Assist in the Revenue Integrity Specialist with prior authorization denials.
    • Perform functions important to daily business of the Revenue Integrity Department.

    Qualifications

    • Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred
    • Bachelors degree preferred 
    • Case Management, Utilization Review or Prior Authorization experience is preferred
    • Minimum of 3 years clinical and/or related experience 
    • Knowledge of third party payer rules and regulations preferred
    • Well organized and able to multi-task quickly and effectively.
    • Works well in high-pressure situations.
    • Ability to work closely and effectively with peers across the organization and with the medical staff. 
    • Motivated, shows initiative, and collaborates well in a team setting. 
    • Ability to be flexible and meet the needs of a growing department. 
    • Shows strong analytical and problem solving skills.
    • Superior written and verbal communication skills
    • Strong understanding and ability to work in various computing/information systems and Microsoft Office product suite. 





    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.

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