Clinical Authorization & Appeals Liaison

Dana-Farber Cancer Institute; Brookline (MA); On-site; USD 84,000 - 95,000; Full time

Job summary

Dana-Farber Cancer Institute in Boston is seeking a Clinical Authorization Specialist to manage prior authorizations for molecular pathology, high-cost drugs, and related services. You will coordinate with clinicians and health plans, serve as a patient advocate, and address denials with appropriate stakeholders.

The role requires a Bachelor’s degree and 1 year of clinical or related experience, with preferred experience in case management or utilization review.

Qualifications

• Bachelor’s degree required.
• 1 year of clinical and/or related experience required.
• Prior Authorization experience preferred.
• Knowledge of third-party payer rules desirable.

Responsibilities

• Manage approval process for clinically complex prior authorization cases.
• Discuss medical necessity with attending physicians and insurers.
• Coordinate with providers to resolve denials and coordinate appeals.
• Create cost estimates for waivers and ABN’s.

Skills

Payer rules knowledge

Analytical skills

Communication

Confidentiality

Education

Bachelor's degree

Tools

Microsoft Office

Job description

Dana-Farber Cancer Institute in Boston is seeking a Clinical Authorization Specialist to manage prior authorizations for molecular pathology, high-cost drugs, and related services. You will coordinate with clinicians and health plans, serve as a patient advocate, and address denials with appropriate stakeholders.

The role requires a Bachelor’s degree and 1 year of clinical or related experience, with preferred experience in case management or utilization review.