Job Description

Overview

The Radiation Oncology Authorization Specialist is responsible for independently coordinating and managing medical necessity-based prior authorizations for radiation oncology services. Working in a high-volume, fast-moving environment, the Radiation Oncology Authorization Specialist applies payer coverage criteria and authorization requirements to ensure financial clearance for radiation oncology services prior to key milestones (consult, CT simulation, treatment start) by reviewing the electronic medical record (EMR) and other aligned tools to compile relevant clinical information. The Specialist also monitors pending cases, addresses payer requests for additional information, and helps coordinate next steps for denials, peer-to-peer reviews, and appeals to reduce delays in patient care. By partnering closely with Radiation Oncology operations, clinicians, scheduling, coding/billing, Patient Financial Services, and payers, the Specialist actively works to reduce delays in care, prevent avoidable denials, improve patient financial experience, and follow-up on related claim denials.

Located in Boston and the surrounding communities, Dana-Farber Cancer Institute is a leader in life changing breakthroughs in cancer research and patient care. We are united in our mission of conquering cancer, HIV/AIDS, and related diseases. We strive to create an inclusive, diverse, and equitable environment where we provide compassionate and comprehensive care to patients of all backgrounds, and design programs to promote public health particularly among high-risk and underserved populations. We conduct groundbreaking research that advances treatment, we educate tomorrow's physician/researchers, and we work with amazing partners, including other Harvard Medical School-affiliated hospitals.

Primary Duties and Responsibilities

Financial Clearance Operations (Front-End Revenue Cycle)

• Review and manage radiation oncology authorization work queues and independently prioritize cases based on treatment start dates, urgency, payer requirements, and financial clearance risk; adjust priorities as needed to support urgent or time-sensitive treatment requests while maintaining accuracy in a fast-paced environment.
• Prepare and submit payer-specific prior authorization requests for radiation oncology services, including physician consultation, simulation, IMRT, IGRT, SBRT, SRS, brachytherapy, and conventional radiation therapy; may include treatment delivery and ongoing course-of-treatment authorization updates; interpret payer medical necessity criteria and applying the appropriate coverage guidelines.
• Review and synthesize clinical documentation including consult notes, treatment plans, pathology results, imaging reports, operative notes, laboratory data, and other associated imaging or treatment-related services as required by payer guideline needed to support authorization requests.  Identifies and gathers the most relevant documentation to meet payer medical policy requirements for radiation therapy and related services.  Tracks pending authorization requests in HER and follows up with health plans to obtain determinations within required timeframes.  Responds to payer requests for additional clinical information and works to resolve issues that may delay authorization.  Communicates authorization outcomes, denials, partial approvals, and payer limitations to appropriate clinical, scheduling, and operational teams. Maintains complete and accurate documentation of all authorization activity in the EMR and other designated systems.
• Coordinate provider-to-payer escalation processes when needed, including peer-to-peer reviews, letters of medical necessity, reconsiderations, and provider-supported appeals.
• Verify insurance eligibility, benefits, referral requirements, and authorization needs using electronic eligibility tools, payer portals, and direct payer communication.  Support denial prevention and perform follow-up on authorization-related claim denials involving radiation oncology services.
• Assist with patient communication related to insurance authorization issues, coverage limitations, or denied services, and provides clear, professional customer service.
• Participate in process improvement efforts related to authorization workflow, payer trends, denial reduction, and operational efficiency.  Perform other duties and special projects as assigned.

Knowledge, Skills and Abilities

• Strong working knowledge of computer systems, electronic medical records, payer portals, and Microsoft Office applications.
• Demonstrated understanding of third-party payer guidelines, insurance plan structures, and prior authorization processes.
• Knowledge of medical terminology and basic clinical concepts, with preference for oncology and radiation oncology terminology to review and interpret clinical documentation and determine appropriate documentation to submit to support medical necessity.
• Strong analytical, organizational, and problem-solving skills.
• Ability to work independently, manage competing priorities, and meet deadlines within established workflows and policies, while maintaining confidentiality of sensitive patient information in accordance with HIPAA and organizational standards.
• Ability to communicate clearly and effectively with payers, providers, clinical staff, patients, and colleagues across departments while using sound judgment, professionalism, tact, and discretion in complex or sensitive situations.
• Ability to perform effectively in a high-volume, deadline-driven environment.

Minimum Job Qualifications

• High school diploma required. Associate’s degree in business administration, management, healthcare, or related field preferred.
• Minimum of 1 year of relevant experience in a hospital, ambulatory, physician practice, oncology, or specialty authorization setting required. Relevant experience may include prior authorization, insurance verification, financial counseling, patient access, medical billing, revenue cycle operations, health insurance, healthcare administration, utilization review, or medical policy review.
• Epic Referrals/Authorizations and/or HB/PB workflow experience preferred.
• ARIA workflow familiarity as it relates to treatment readiness and documentation handoffs preferred.
• Experience working with third-party payers and authorization requirements preferred.
• Prior oncology or radiation oncology experienced preferred.

License/Certification/Registration Required: None

Supervisory Responsibilities: No

Patient Contact: Yes

• Occasional patient contact by email or phone.

Special Working Conditions:

• Fast-paced, multi-entity healthcare and academic environment.
• Occasional requirement to respond to urgent project or operational issues outside standard business hours.

At Dana-Farber Cancer Institute, we work every day to create an innovative, caring, and inclusive environment where every patient, family, and staff member feels they belong. As relentless as we are in our mission to reduce the burden of cancer for all, we are committed to having faculty and staff who offer multifaceted experiences. Cancer knows no boundaries and when it comes to hiring the most dedicated and compassionate professionals, neither do we. If working in this kind of organization inspires you, we encourage you to apply.

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 characteristics protected by law.  

Pay Transparency Statement

The hiring range is based on market pay structures, with individual salaries determined by factors such as business needs, market conditions, internal equity, and based on the candidate’s relevant experience, skills and qualifications.

For union positions, the pay range is determined by the Collective Bargaining Agreement (CBA).

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