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Sr Referral Specialist

Dana-Farber Cancer Institute

Job Description

Sr Referral Specialist

Job ID:

32017

Location:

450 Brookline Ave, Boston, MA 02215

Category:

Finance/Accounting/Billing

Employment Type:

Full time

Work Location:

Full Remote: 4-5 days remote/wk

Overview

Reporting to the Referral Supervisor, the Senior Referral Specialist is primarily responsible for assisting the Referral Supervisor with daily team operations. Responsibilities include but are not limited to providing feedback on referral/authorization processes, providing support to staff as necessary, and assisting the Referral Supervisor in educating staff of any changes pertaining to their roles and responsibilities.

This position is also responsible for submitting referrals and out of network authorizations, confirming insurance eligibility, appealing both pre and post claim denials, and completing assigned work in a timely and accurate fashion.

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.

Responsibilities

PRIMARY DUTIES AND RESPONSIBILITIES:

  • Assists Referral Supervisor in monitoring the daily referral and out-of-network authorization processes related to the scope of the Dana-Farber Cancer Institute Referral and Clinical Authorization Department.
  • Assists staff to ensure the team is meeting insurance requirements (i.e., providing appropriate CPT codes) and pursuing insurance approval for challenging cases to resolve referral/authorization issues before rendering the service.
  • Assists in resolving patient concerns surrounding referral/authorization.
  • Provides training to new and existing employees.
  • Provides feedback to the supervisor on staff performance.
  • Assists in the oversight of the daily denial workflows including retroactive referrals and authorizations, radiation oncology, and writing/filing appeals to the payers.
  • Assists the Referral team in updating practices and workflows for new DFCI services (i.e., telemedicine)
  • Ensures Epic tools are streamlined to support workflows.
  • Supports new initiatives for securing PCP referrals, such as outsourcing and other technical solutions.
  • Submits referrals and out of network authorizations. Confirms insurance eligibility and appeals both pre and post claim denials.
  • Performs other duties as assigned.

Qualifications

MINIMUM JOB QUALIFICATIONS:

  • High school diploma or equivalent required; Bachelor’s degree in related field preferred
  • 3 years referral and/or related experience required

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:

  • Strong understanding and ability to work in various computing/information systems and Microsoft Office product suite.
  • Demonstrated knowledge of payer rules and regulations.
  • Strong analytical and problem-solving skills.
  • Ability to mentor and educate team members, including leading by example.
  • Ability to function independently and prioritize work within established policies.
  • Ability to work with sensitive patient information and maintain confidentiality.
  • Ability to work closely and effectively with colleagues across the organization including clinical staff.
  • Ability to use good judgment, tact, and sensitivity.
  • Ability to function in a fast paced, highly demanding environment.

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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