Dana-Farber Cancer Institute
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 Radiology Authorization Coordinator will manage the work of various clinical and revenue cycle groups in attempts to secure prior authorizations and financial clearance for radiology exams. 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. His/her responsibilities include, but are not limited to: working with upstream registration, referrals and financial counseling teams, requesting referrals and letters of agreement, coordinating physician-to-physician discussions, requesting and reviewing letters of medical necessity, and coordinating financial clearance for DFCI and outside imaging center Radiology departments. If necessary, the Radiology Authorization Coordinator will independently complete various aspects of this work (e.g. request referral, confirm eligibility). This position reports directly to the Radiology Authorization Supervisor.
Independently identifies and prioritizes imaging procedures with the greatest financial reimbursement risk (e.g. out of network insurances, high-risk imaging indications).
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.
Interacts professionally and effectively with clinicians, patients, and insurance companies.
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.
Verifies insurance eligibility and benefits, utilizing automated eligibility systems, payer portals, or telephone communication.
Maintains organized, detailed summaries of prior authorization requests to support post-claim denial workflows. Updates and maintains prior authorizations tools and spreadsheets.
Completes appropriate post-claim denial follow-up to overturn radiology-related prior authorization claim denials.
Additional duties as assigned.
High School diploma/GED required. Bachelors degree highly desired. Preference to healthcare/business administration, nursing, other allied health fields, and/or appropriate science course work (e.g. Biology. Pre-med).
2 years relevant work experience. Experience includes, but 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.
Some knowledge of medical terminology preferred.
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.
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.