Patient Financial Clearance & Authorization Specialist

Dana-Farber Cancer Institute; Boston (MA); On-site; USD 50,000 - 60,000; Full time

Job summary

Dana-Farber Cancer Institute in Boston is seeking a Financial Clearance Specialist to serve as a patient liaison for pre-service financial clearance and ongoing authorization, ensuring accurate documentation and adherence to payer guidelines.

The role requires strong customer service, attention to detail, and the ability to work with sensitive information in a fast-paced environment; familiarity with Epic and payer rules is preferred. This is a full-time, on-site position.

Qualifications

• Strong customer service and communication skills, both written and verbal.
• Strong relationship building skills and collaboration abilities.
• Solid analytical and problem-solving skills.
• Ability to prioritize work with direction within established policies and meet deadlines in a fast-paced environment.
• Ability to work with sensitive patient information and maintain confidentiality; good judgment and tact.
• Working knowledge of Epic or other hospital information systems.
• Demonstrated knowledge of third-party payer rules and regulations.
• Proficiency in Microsoft Office preferred.

Responsibilities

• Reviews and monitors new patient daily appointment records and identifies patients with plans requiring prior authorization.
• Verifies insurance benefits using eligibility systems, payer portals, and/or phone contact.
• Communicates financial clearance process to patients including benefits, network status, and authorization requirements; assists with issues before treatment.
• Reprioritizes work for clinically urgent patients and maintains high-quality work under time constraints.
• Monitors patient work queues to obtain required authorization/referrals per payer guidelines.
• Works with patients and PCPs to complete payer-specific prior authorization forms and applies guidelines.
• Responds to health plan prior authorization requests that do not meet policy criteria and coordinates with health plans.
• Communicates effectively with DFCI staff regarding financial clearance status.
• Maintains accurate records to support post-claim denial workflows.
• Completes assigned work queues, projects, and other duties as directed.

Skills

Customer service

Communication

Relationship building

Analytical skills

Prioritization

Confidentiality

Epic knowledge

Payer rules knowledge

Microsoft Office

Education

High school diploma or GED

Bachelor’s Degree preferred

Tools

Epic

Microsoft Office

Job description

Dana-Farber Cancer Institute in Boston is seeking a Financial Clearance Specialist to serve as a patient liaison for pre-service financial clearance and ongoing authorization, ensuring accurate documentation and adherence to payer guidelines.

The role requires strong customer service, attention to detail, and the ability to work with sensitive information in a fast-paced environment; familiarity with Epic and payer rules is preferred. This is a full-time, on-site position.