Senior Clinical Authorization Specialist

Location: Brookline, Massachusetts, with occasional onsite work

Salary: $110,200–$123,200 per year

Company

hirify.global provides cancer research, patient care, medical education, and public health programs in collaboration with Harvard Medical School-affiliated hospitals.

What you will do

• Manage complex prior authorizations for on-label and off-label drugs, laboratory testing, molecular pathology, and other clinical services.
• Communicate medical necessity information to insurers and coordinate provider-to-payer medical director discussions.
• Review denials, prepare and submit appeals, coordinate peer-to-peer discussions, and reprocess claims.
• Create drug cost estimates, waivers, and ABNs while communicating coverage options and assistance programs to clinical teams.
• Monitor authorization queues and mailboxes, triage inquiries, resolve complex payer questions, and escalate cases appropriately.
• Mentor and train staff, maintain training resources, and contribute feedback to quality and process improvement initiatives.

Requirements

• Bachelor’s degree required; BSN preferred.
• At least 4 years of clinical or related experience.
• At least 2 years of previous experience as a Clinical Authorization Specialist II.
• Strong knowledge of third-party payer rules and regulations is highly desirable.
• Strong analytical, problem-solving, judgment, communication, and prioritization skills.
• Registered Nurse license in the Commonwealth of Massachusetts is preferred.

Culture & Benefits

• Full-time hybrid work with occasional onsite presence in Brookline.
• Work in an inclusive, diverse, and equitable environment focused on compassionate patient care.
• Collaborate with physicians, clinical staff, Revenue Integrity, Billing Compliance, and other organizational teams.
• Contribute to cancer research, treatment advancement, medical education, and public health programs.