Manager, Radiation Oncology Authorizations

Overview

The Manager of Radiation Oncology Authorizations leads a front-end revenue cycle team responsible for pre-service financial clearance for Radiation Oncology in an outpatient hospital setting. This role ensures patients are financially cleared prior to key milestones (consult, CT simulation, treatment start) through accurate registration validation, eligibility/benefits verification, Medicare guideline support, medical-necessity readiness, referral management, and prior authorization acquisition.

The Manager serves as the operational subject matter expert for payer requirements impacting access to care and compliant reimbursement, with a strong focus on Medicare (Traditional and Medicare Advantage), payer medical policies, and documentation needed to support coverage. The role partners closely with Radiation Oncology operations, clinicians, scheduling, coding/billing, Patient Financial Services, and payers using Epic and ARIA to reduce delays, prevent avoidable denials, and improve the patient financial experience.

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.

Primary Duties and Responsibilities

• Manage day-to-day financial clearance workflow for Radiation Oncology, ensure completion and documentation of required steps prior to scheduled services (consult, CT sim, planning, treatment delivery); maintain focus on registration accuracy, insurance benefits interpretation / limitations, and payer authorization requirements / changes.
• Lead the end-to-end prior authorization process for Radiation Oncology services, ensure accurate capture of authorization details for radiation oncology, including, but not limited to, CPT/HCPCS, diagnosis linkage, number of fractions/units, date span, site of service, rendering/ordering provider, facility NPI/TIN, and any payer-specific conditions. Coordinate timely collection and submission of clinical documentation required for approval; identify missing documentation elements and route to clinical teams for completion. Manage escalations including peer-to-peer coordination, urgent requests, retro-authorization risk mitigation, and payer follow-up to prevent delays in treatment.
• Support adherence to Medicare coverage and documentation expectations by maintaining team workflows that align to CMS rules and commonly applied Medicare administrative guidance (e.g., NCD/LCD awareness, required documentation elements, correct beneficiary/plan identification). Facilitate appropriate ABN workflow routing and support in coordination with Access and Financial Engagement, Patient Financial Services and clinical leadership.
• Establish and monitor key performance metrics aligned with prior authorization (e.g., clearance rate prior to service date, authorization turnaround time, peer-to-peer cycle time, avoidable denial rate, reschedule rate due to clearance).
• Partner with Radiation Oncology operations to ensure financial clearance status is visible and actionable in scheduling and treatment readiness workflows; implement escalation pathways for approaching start dates. Ensure clear, standardized, audit-ready documentation in Epic (referrals/authorizations, coverage notes, attachments) and appropriate handoffs/visibility for downstream users (billing, coding, denials, clinical operations).
• Analyze and appeal authorization and claim denials tied to front-end defects; e.g., missing/invalid authorization, plan selection errors, coverage termed, referral missing, health plan requirements not met, technical infrastructure gaps. Implement corrective actions: standard work, checklists, payer-specific playbooks, targeted staff retraining, and workflow improvements to reduce rework and denials.
• Supervise, coach, and develop a team of financial clearance/authorization specialists. Manage staffing plans, workload distribution, quality monitoring, performance reviews, and training/onboarding. Build a high-accountability, patient-centered remote team culture.
• Ensure secure communication practices and consistent coverage during PTO/peak volume. Maintain HIPAA-compliant handling of PHI and ensure payer communications and documentation standards support audit readiness. Conduct routine quality audits of authorization accuracy, Medicare-related documentation support, and clearance completion; partner on corrective action plans when issues are identified.

Knowledge, Skills and Abilities

• Strong knowledge of financial clearance and prior authorization operations in an outpatient hospital environment.
• Working knowledge of Medicare (Traditional and Medicare Advantage) requirements impacting Radiation Oncology access and reimbursement, including medical necessity/documentation expectations and common denial drivers.
• Ability to interpret payer medical policies and translate them into clear team workflows and payer-specific job aids.
• Proficiency in Epic workflows supporting referrals/authorizations/coverage documentation; familiarity with ARIA as it relates to treatment readiness coordination.
• Strong operational discipline: KPI management, root-cause analysis, process improvement, and sustaining standard work.
• Excellent written and verbal communication skills to coordinate with payers, patients, clinical teams, and revenue cycle partners—especially in a remote environment and highly matrixed organization.
• Demonstrated people leadership skills: coaching, performance management, and building consistent team execution.

Minimum Job Qualifications

• Bachelor’s degree required.
• 5+ years of experience in revenue cycle operations, financial clearance, authorizations, or related field required.
• 2+ years of people leadership experience (supervisor/manager) required.
• 2+ years supporting Radiation Oncology access/clearance, authorizations, billing, or denials-prevention workflows required.
• Experience with Medicare (Traditional and MA), Medicaid, and commercial payers including payer portals, medical policy review, and authorization rules required.
• Experience coordinating with hospital and/or professional registration and financial counseling functions required.
• Epic Referrals/Authorizations and/or HB/PB workflow experience preferred.
• ARIA workflow familiarity as it relates to treatment readiness and documentation handoffs preferred.
• Experience in an outpatient hospital and ambulatory setting preferred.
• Epic certification preferred.
• HCCA Certification in Healthcare Compliance (CHC) preferred.

License/Certification/Registration Required: None

Supervisory Responsibilities: Yes

• Directly supervises up to 10 Revenue Cycle Specialists.

Patient Contact: Yes

• Occasional patient contact by email or phone.

Special Working Conditions:

• Fast-paced, multi-entity healthcare and academic environment.
• Occasional requirement to respond to urgent project or operational issues outside standard business hours.

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 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 characteristics protected by law.

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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).

$90,200.00 - $98,900.00