Radiology Authorization Specialist

Job Details

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Job ID:
25947

Location:
10 Brookline Place West, Brookline, MA 02445

Category:
Finance/Accounting

Employment Type:
Full time

Work Location:
Full Remote: 4-5 days remote/wk

Overview

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.

The Radiology Authorization Coordinator reports to the Radiology Authorization Supervisor. Working in a fast-paced, high-volume, dynamic environment, the Radiology Authorization Coordinator is responsible for independently managing all work related to medical necessity-based authorizations for all diagnostic imaging services (planned and unplanned) ordered by Dana-Farber Cancer Institute (DFCI) providers.

The Radiology Authorization Coordinator will demonstrate strong understanding of payer coverage policies, applying appropriate payer guidelines to all aspects of radiology prior authorization work. S/He will leverage his/her strong understanding of medical terminology and physiology to call out appropriate clinical documents (e.g. progress notes, lab values, scan results) with the electronic medical record (EMR). The Radiology Authorization Coordinator will create thorough, concise prior authorization requests to all payers.

Requirements

  • Reviews and monitors all radiology authorization work
  • Independently identifies and prioritizes imaging procedures with the greatest financial reimbursement risk (e.g. out of network insurances, high-risk imaging indications).
  • Reprioritizes work to respond to clinically urgent diagnostic imaging procedures – produces high quality work under pressure.
  • Verifies insurance eligibility and benefits, utilizing automated eligibility systems, payer portals, or telephone communication.
  • Independently identifies upstream revenue cycle barriers to prior authorization workflows. Coordinates appropriate teams or independently resolves upstream barriers to allow prior authorization work to continue.
  • Prepares and completes payer-specific prior authorization requests, interprets medical policy criteria, and applies appropriate guidelines to prior authorization requests.
  • Reviews and comprehends patient progress notes, lab reports, infusion summaries, imaging reports, and plan of care. Identifies appropriate medical documentation that satisfies payer medical policy criteria.
  • Independently determines when documentation does not meet medical policy guidelines works with clinic providers and administrative support staff to obtain appropriate documentation.
  • Responds to health plan-reviewed prior authorization request that do not meet initial policy criteria. Works with the health plan to resolve issues (e.g. provides additional clinical documentation via phone, fax, or online portal).
  • Coordinates appropriate provider-to-health plan interventions (e.g. peer-to-peer discussions, letters of medical necessity, provider-initiated appeals, etc.).
  • Disseminates appropriate authorization status information to appropriate parties for all cases. Stake holders include but are not limited to: providers, clinic administrative support, radiology scheduling, and patients.
  • Follows-up with patients in the case of denied coverage of a radiology exam. Provides superior customer service to all patients, works through patient-raised issues, and recommends appropriate solutions.
  • Manages difficult conversations well. Is calm, professional, and thoughtful engaging in conversations with patients and DFCI staff (e.g. providers).
  • Follows-up with appropriate parties to meet all deadlines and prevent prior authorization denials.
  • Manages prior authorization process from initial submission to authorization for all assigned cases.
  • Maintains organized, detailed summaries of prior authorization requests to support post-claim denial workflows.
  • Completes appropriate post-claim denial follow-up to overturn radiology-related prior authorization claim denials.
  • Updates and maintains prior authorization tools and spreadsheets.
  • Assists in the orientation and training of new staff.
  • Completes assigned work, projects, and other duties as assigned.

Qualifications

  • Bachelor’s degree preferred highly desired. Preference to healthcare/business administration, nursing, other allied health fields, and/or appropriate science course work (e.g. Biology, Pre-med)
  • High School Diploma or GED required.
  • 2-years work experience. Experiences include, but are not limited to: healthcare/business administration, health insurance, medical policy/chart review, nursing, and/or pharmacy. Appropriate science and healthcare graduate course work can be substituted.
  • Performs primary duties independently and progresses toward performing more advanced tasks, as directed.
  • Superior knowledge of outpatient hospital revenue cycle workflows and systems.

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:

  • Expert analytical and problem solving skills
  • Identifies key stakeholders and coordinates efforts appropriately.
  • Efficiently manages multiple tasks at once.
  • Excellent organizational skills with a strong attention to detail.
  • Excellent communication skills – effectively interacts with patients and all levels of staff (physicians, mid-level practitioners, senior management) and external contacts. Manages difficult conversations well.
  • Superior technical skills – quickly navigates through Microsoft Office products, web-based portals, excel databases, and electronic medical records.

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 equally committed to diversifying our faculty and staff.  Cancer knows no boundaries and when it comes to hiring the most dedicated and diverse 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 groups as protected by law.

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