Clinical Authorization Specialist

Location: Brookline, Massachusetts, United States; remote work with occasional onsite attendance

Salary: $83,500–$95,400 per year

Company

hirify.global conducts cancer research, delivers patient care, educates physician-researchers, and promotes public health.

What you will do

• Manage clinically complex prior authorizations for on-label and off-label drugs, molecular pathology, laboratory testing, and other services.
• Discuss medical necessity cases with attending physicians and communicate clinical information to health plans.
• Conduct medical literature searches and coordinate provider-to-payer medical director discussions.
• Review denials, coordinate appeals, reprocess claims, and resolve coverage issues before molecular pathology testing.
• Create drug cost estimates, waivers, and ABNs while communicating assistance program options to clinical teams.
• Monitor authorization queues and shared mailboxes, triage payer inquiries, and support Revenue Integrity and Billing Compliance.

Requirements

• Bachelor’s degree required; BSN preferred.
• At least one year of clinical or related experience required.
• Ability to analyze complex medical situations, solve problems, prioritize work, and meet deadlines in a high-pressure environment.
• Ability to handle sensitive patient information confidentially and collaborate effectively with medical staff and colleagues.
• Ability to work with multiple information systems and Microsoft Office products.
• Registered Nurse license in the Commonwealth of Massachusetts is preferred.

Nice to have

• Experience in case management, utilization review, or prior authorization.
• Knowledge of third-party payer rules and regulations.
• Experience mentoring and educating team members.

Culture & Benefits

• Work in an innovative, caring, inclusive, and equitable healthcare environment.
• Collaborate with Harvard Medical School-affiliated hospitals and other healthcare partners.
• Contribute to cancer research, treatment advancement, patient care, and public health programs.
• Remote work is available with occasional onsite attendance.