PRIOR AUTHORIZATION SPECIALIST
Company: Dana-Farber Cancer Institute
Posted on: May 1, 2021
Overview Located in Boston and the surrounding communities,
Dana-Farber Cancer Institute brings together world renowned
clinicians, innovative researchers and dedicated professionals,
allies in the common mission of conquering cancer, HIV/AIDS and
related diseases. Combining extremely talented people with the best
technologies in a genuinely positive environment, we provide
compassionate and comprehensive care to patients of all ages; we
conduct research that advances treatment; we educate tomorrow's
physician/researchers; we reach out to underserved members of our
community; and we work with amazing partners, including other
Harvard Medical School-affiliated hospitals.The Prior Authorization
Nurse Specialist will work within the Revenue Integrity & Billing
Compliance team to bring additional clinical expertise to the prior
authorization and appeals processes. The Nurse Specialist will be
the clinical support person for high cost drug authorizations and
off-label chemotherapy authorizations as well as have primary
responsibility for appealing rejected claims to payers. The Nurse
Specialist will serve as a liaison and patient advocate between the
Dana-Farber and health insurance company representatives. This role
requires a detail-oriented person who can manage multiple efforts
to completion with minimal oversight. Responsibilities
- Submit clinical documentation for authorization of various high
cost pharmaceuticals, radiopharmaceuticals, and off-label
- Collaborate as part of an inter-disciplinary team related to
the previously mentioned processes.
- Serve as a clinical resource to the Revenue Integrity & Billing
- Collaborate with the Prior Authorization Manager to review and
appeal rejected claims in a timely fashion.
- Assist in the Revenue Integrity Specialist with prior
- Perform functions important to daily business of the Revenue
Integrity Department. Qualifications
- Licensed as a Registered Nurse in the Commonwealth of
- Bachelors degree preferred
- Case Management, Utilization Review or Prior Authorization
experience is preferred
- Minimum of 3 years clinical and/or related experience
- Knowledge of third party payer rules and regulations
- Well organized and able to multi-task quickly and
- Works well in high-pressure situations.
- Ability to work closely and effectively with peers across the
organization and with the medical staff.
- Motivated, shows initiative, and collaborates well in a team
- Ability to be flexible and meet the needs of a growing
- Shows strong analytical and problem solving skills.
- Superior written and verbal communication skills
- Strong understanding and ability to work in various
computing/information systems and Microsoft Office product suite.
Dana-Farber Cancer Institute is an equal opportunity employer and
affirms the right of every qualified applicant to receive
consideration for employment without regard to race, color,
religion, sex, gender identity or expression, national origin,
sexual orientation, genetic information, disability, age, ancestry,
military service, protected veteran status, or other groups as
protected by law.
Keywords: Dana-Farber Cancer Institute, Brookline , PRIOR AUTHORIZATION SPECIALIST, Other , Brookline, Massachusetts
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