Top 334 Prior authorization remote Jobs in Boston, Ma

Clinical Authorization Specialist
Dana-Farber Cancer Institute —Brookline, MA
- $83,500 - $95,400 a year
- Full-time
- Nursing
- Mid-level
- Mentoring
6h
Authorization Specialist
New England Life Care —Canton, MA
- $21 - $22 an hour
- Full-time
- Microsoft Word
- Microsoft Excel
- Customer service
- Disability insurance
- Health insurance
Quick Apply
Patient Experience Representative (7:00am-3:30pm)
Boston Children's Hospital —Boston, MA
- $19.83 - $29.49 an hour
- Weekends as needed
- Administrative experience
- High school diploma or GED
- Bachelor's degree
3d
Patient Support Supervisor - Certified Pharmacy Technician, Prior Authorizations
Shields Health Solutions —Stoughton, MA
- Remote
- Microsoft Outlook
- Mid-level
- High school diploma or GED
- Paid time off
Quick Apply
Patient Experience Representative (24 hours)
Boston Children's Hospital —Boston, MA
- $19.83 - $29.49 an hour
- Part-time
- Administrative experience
- High school diploma or GED
- Bachelor's degree
Clinical Policy Configuration Specialist
Cohere Health —Boston, MA
- $65,000 - $80,000 a year
- Remote
- Microsoft Word
- Nursing
- Microsoft Excel
- Paid parental leave
- Health savings account
Quick Apply
Client Support Specialist
Cohere Health —Boston, MA
- $55,000 - $60,000 a year
- Remote
- Computer Science
- Mid-level
- Analysis skills
- Paid parental leave
- Health savings account
Quick Apply
4d
Patient Experience Representative - Immunology Call Center
Boston Children's Hospital —Boston, MA
- $19.83 - $29.49 an hour
- Full-time
- Administrative experience
- High school diploma or GED
- Bachelor's degree
Patient Experience Representative- CACU: 3-11pm weekends
Boston Children's Hospital —Boston, MA
- $19.83 - $29.49 an hour
- Part-time
- Acute care
- Hospital
- Administrative experience
6d
Medical Policy Writer
Cohere Health —Boston, MA
- $80,000 - $100,000 a year
- Remote
- Nursing
- Research
- Mid-level
- Paid parental leave
- Health savings account
Quick Apply
Patient Experience Representative- 11pm-7:30am every other Sat/Sun
Boston Children's Hospital —Boston, MA
- $19.83 - $29.49 an hour
- Part-time
- Hospital
- Office
- Administrative experience
10d
Member Services Associate
RapidRatings —Quincy, MA
- $55,000 a year
- Online Application
- Hybrid work
- English
- Mid-level
- Office
Quick Apply
Patient Experience Representative I - Ambulatory (Part-Time)
Boston Children's Hospital —Boston, MA
- $19.83 - $29.49 an hour
- Part-time
- Administrative experience
- High school diploma or GED
- Bachelor's degree
14d
Neuropsychology Technician
Boston Children's Hospital —Waltham, MA
- $19.83 - $29.49 an hour
- Full-time
- Clinic experience
- Mid-level
- Clinic
Patient Experience Representative- 12-9:30pm M-F
Boston Children's Hospital —Boston, MA
- $19.83 - $29.49 an hour
- Overnight shift
- Administrative experience
- High school diploma or GED
- Bachelor's degree
- Health insurance
- Dental insurance
10d
Expanded Practice Support Assistant
Optum —Quincy, MA
- $18 - $32 an hour
- Full-time
- Hybrid work
- Private practice
- Pass drug screening
- Mid-level
- AD&D insurance
- Employee stock purchase plan
Patient Experience Representative (3:00pm-11:30pm)
Boston Children's Hospital —Boston, MA
- $19.83 - $29.49 an hour
- Full-time
- Administrative experience
- High school diploma or GED
- Bachelor's degree
Practice Support Assistant II
Optum —Wellesley, MA
- $17.98 - $32.12 an hour
- Full-time
- Hybrid work
- Pass drug screening
- Mid-level
- High school diploma or GED
- AD&D insurance
- Employee stock purchase plan
Hybrid Remote-In Office Insurance Verification and Billing Specialist
OTA Kids Pediatric Therapy —Wakefield, MA
- $22 - $26 an hour
- Part-time
- Hybrid work
- 5 years
- Computer literacy
- Medical office experience
Quick Apply
Procurement Specialist (Buyer)
Raytheon —Boston, MA
- $68,900 - $131,100 a year
- Full-time
- Remote
- Microsoft Excel
- Mid-level
- Analysis skills
- Paid holidays
- Disability insurance
2d

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Clinical Authorization Specialist

Dana-Farber Cancer Institute -
Brookline, MA

Apply Now

Job Details

Full-time
$83,500 - $95,400 a year
6 hours ago

Qualifications

Collaborate with healthcare professionals
Healthcare privacy protection
Mentoring
Productivity software

Full Job Description

Job Ref:

JR-7218

Location:

10 Brookline Place, BROOKLINE, MA 02445

Category:

Quality/Risk Management/Patient Safety

Employment Type:

Full time

Work Location:

Remote: occasional onsite

Salary/Pay Rate:

$83,500.00 - $95,400.00 per year

Overview

Working in a fast-paced, high volume, dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve as a liaison and patient advocate between Dana Farber Cancer Institute and various health plans.
Reporting to the Prior Authorization Supervisor, the Clinical Authorization Specialist is responsible for managing all work related to molecular pathology, high-cost drug, and off-label drug authorizations. The Clinical Authorization Specialist is also responsible for managing denials related to front-end prior authorization, biosimilar drugs, pharmacy-benefit exclusion drugs, and claims.

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.

With direct oversight, the Clinical Authorization Specialist:

Manages approval process for clinically complex cases:

Discusses complex medical necessity cases in all aspects of the prior authorization work (on-label drug, off-label drug, laboratory testing, and others as assigned) with attending physicians.

Understands clinically complex medical situations and communicates appropriate medical information to the insurer.

Completes medical literature searches and/or coordinates appropriate provider-to-payer medical director discussions.

Collaborates with attending physicians on treatment alternatives when medical necessity coverage denials cannot be overturned.

Appropriately escalates complex cases to Drug Authorization Supervisor or Manager of Prior Authorizations.

Monitors email communication to the Drug Authorization Mailbox and distribution lists:

Triages work to the appropriate staff member or assists with finding the correct team for the inquiry.

Answers complex payer-related questions.

Coordinates with clinicians and other staff members to help resolve more complex inquiries.

Assists Drug Authorization Specialists with medical necessity denial review:

Ensures that all necessary medical information was provided to the third-party payer.

If necessary, helps clinical team understand denial and coordinates appeal process.

Creates cost estimates for waivers.

Root causes claim denials, reprocesses, and submits claim appeals.

Creates drug cost estimates for both on-label and off-label waivers and ABN’s. Communicates cost estimates to the clinical team and provides guidance on available assistance programs.

Completes Molecular Pathology requests with the goal of resolving coverage issues prior to performing the testing.

Review and monitor the drug authorization work queue, identifying patient treatment/therapy plans that require prior authorization.

Serve as a clinical resource to the Revenue Integrity and Billing Compliance team.

Performs other duties as assigned.

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:

Knowledge of third-party payer rules and regulations highly desirable.
Good judgment, tact, sensitivity, and the ability to function in a fast paced, highly demanding environment.
Analytical and problem-solving skills.
Understanding and ability to work in various computing/information systems and Microsoft Office product suite.
Ability to mentor and educate team members, including by example.
Ability to function independently and prioritize work within established policies.
Ability to prioritize, meet pre-determined deadlines and work in high pressure situations.
Ability to work with sensitive patient information and maintain confidentiality.
Ability to work closely and effectively with colleagues across the organization including medical staff.

MINIMUM JOB QUALIFICATIONS:

Minimum Education:

Bachelor’s degree required. BSN preferred.

Minimum Experience:

1 year of clinical and/or related experience required. Case Management, Utilization Review and/or Prior Authorization experience is preferred.

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 .

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.

EEO Poster

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).

$83,500.00 - $95,400.00

Apply Now

Refine Your Search

prior authorization remote jobs in boston, ma

Clinical Authorization Specialist

Authorization Specialist

Patient Experience Representative (7:00am-3:30pm)

Patient Support Supervisor - Certified Pharmacy Technician, Prior Authorizations

Patient Experience Representative (24 hours)

Clinical Policy Configuration Specialist

Client Support Specialist

Patient Experience Representative - Immunology Call Center

Patient Experience Representative- CACU: 3-11pm weekends

Medical Policy Writer

Patient Experience Representative- 11pm-7:30am every other Sat/Sun

Member Services Associate

Patient Experience Representative I - Ambulatory (Part-Time)

Neuropsychology Technician

Patient Experience Representative- 12-9:30pm M-F

Expanded Practice Support Assistant

Patient Experience Representative (3:00pm-11:30pm)

Practice Support Assistant II

Hybrid Remote-In Office Insurance Verification and Billing Specialist

Procurement Specialist (Buyer)

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