Radiology Prior Authorization Expert

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

Job summary

Dana-Farber Cancer Institute seeks a Radiology Authorization Specialist to manage prior authorizations for diagnostic imaging. You will collect clinical documentation, prepare payer-specific requests, and ensure compliance with policy guidelines.

In this high-volume role, you will collaborate with clinical staff and health plans to resolve issues, support appeals when necessary, and maintain accurate records while protecting patient confidentiality.

Qualifications

• Strong understanding of payer rules and regulations.
• Strong knowledge of medical terminology and physiology.
• Proficiency with Microsoft Office and EMR systems.
• Ability to work independently and prioritize under policy guidance.

Responsibilities

• Manage medical necessity-based authorizations for all diagnostic imaging services.
• Retrieve clinical documents from EMR to support prior authorization requests.
• Prepare and submit payer-specific authorization requests with policy criteria.
• Communicate with health plans to resolve issues and initiate appeals if needed.
• Follow up on denied coverage and overturn denials where possible.
• Maintain timely, accurate documentation and ensure patient confidentiality.

Job description

Dana-Farber Cancer Institute seeks a Radiology Authorization Specialist to manage prior authorizations for diagnostic imaging. You will collect clinical documentation, prepare payer-specific requests, and ensure compliance with policy guidelines.

In this high-volume role, you will collaborate with clinical staff and health plans to resolve issues, support appeals when necessary, and maintain accurate records while protecting patient confidentiality.