Clinical Authorization & Payer Liaison Specialist

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

Job summary

Dana-Farber Cancer Institute in Boston seeks a Clinical Authorization Specialist to navigate prior authorization, appeals, and complex molecular pathology authorizations. You will collaborate with physicians and payers to secure coverage for high-cost and off-label therapies, and you will act as a patient advocate throughout the process.

Reporting to the Prior Authorization Supervisor, the role emphasizes understanding payer rules, maintaining confidential patient information, and guiding the

Qualifications

• Bachelor’s degree required; BSN preferred.
• 1 year of clinical and/or related experience required. Case Management, Utilization Review and/or Prior Authorization experience is preferred.
• Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred.

Responsibilities

• Manages approval process for clinically complex cases.
• Triages payer inquiries and directs to appropriate staff.
• Communicates with insurers and medical directors.
• Assists with denial review and coordination of appeals.
• Creates cost estimates for waivers and assists with the appeals process.

Skills

Payer rules knowledge

Analytical skills

Communication skills

Mentoring

Independent work

Confidentiality

Team collaboration

Education

Bachelor's degree

BSN preferred

Tools

Microsoft Office

Job description

Dana-Farber Cancer Institute in Boston seeks a Clinical Authorization Specialist to navigate prior authorization, appeals, and complex molecular pathology authorizations. You will collaborate with physicians and payers to secure coverage for high-cost and off-label therapies, and you will act as a patient advocate throughout the process.

Reporting to the Prior Authorization Supervisor, the role emphasizes understanding payer rules, maintaining confidential patient information, and guiding the