Radiology Prior Authorization Expert

Dana-Farber Cancer Institute; Boston (MA); On-site; USD 44,000 - 48,000; Full time

Job summary

Dana-Farber Cancer Institute in Boston, MA is seeking a Radiology Authorization Specialist who will independently manage medical necessity-based prior authorizations for diagnostic imaging ordered by DFCI providers.

In a fast-paced, high-volume setting, you will apply payer guidelines, review EMR documents, prepare clear authorization requests, verify benefits, and communicate with plans and patients to resolve issues.

Qualifications

• High school diploma or GED required; associate or bachelor’s degree preferred.
• 0 years required; 1 year of relevant work experience preferred in hospital/ambulatory settings, prior authorization, billing, or related areas.
• Knowledge of third-party payer rules and medical policy criteria.
• Ability to work independently, prioritize, and maintain confidentiality.

Responsibilities

• Reviews radiology authorization work queues and prioritizes imaging procedures with highest reimbursement risk.
• Prepares payer-specific prior authorization requests and interprets policy criteria.
• Verifies insurance eligibility and benefits using automated systems or payer portals.
• Interprets patient records and ensures documentation meets payer criteria.
• Responds to requests that do not meet criteria and coordinates with providers and payers.
• Follows up on denials and resolves issues to overturn improper authorizations.
• Maintains patient confidentiality in all interactions.
• Performs other duties as assigned.

Skills

Medical terminology

Payer rules

Prior authorization

Analytical skills

MS Office

Independent prioritization

Confidentiality

Team collaboration

Judgment

Education

High school diploma or GED

Associate or Bachelor’s degree preferred

Tools

EMR systems

Microsoft Office

Job description

Dana-Farber Cancer Institute in Boston, MA is seeking a Radiology Authorization Specialist who will independently manage medical necessity-based prior authorizations for diagnostic imaging ordered by DFCI providers.

In a fast-paced, high-volume setting, you will apply payer guidelines, review EMR documents, prepare clear authorization requests, verify benefits, and communicate with plans and patients to resolve issues.