Oncology Prior Authorisation

Role Overview

As a CoverMyMeds Specialist, you will be responsible for managing electronic prior authorizations (ePAs) and ensuring timely and accurate processing of oncology-related prescriptions. You will work closely with prescribers, pharmacies, and payers to streamline access to critical oncology treatments and minimize delays in patient care.

Key Responsibilities

• Manage and process electronic prior authorizations (ePAs) through CoverMyMeds, focusing on oncology medications.
• Review clinical documentation and ensure completeness and accuracy for payer submission.
• Collaborate with healthcare providers, insurance companies, and specialty pharmacies to resolve prior authorization and reimbursement issues.
• Monitor and track prior authorization requests, ensuring timely follow-up and resolution.
• Educate prescribers' offices and staff on CoverMyMeds processes and payer requirements.
• Stay updated on oncology drug access pathways, insurance policies, and payer-specific rules.
• Document case activities accurately in CRM or patient management systems.
• Work cross-functionally with Risa Labs' internal teams to support patient access initiatives.

Qualifications

• Bachelor's degree in healthcare, pharmacy, life sciences, or a related field (preferred).
• 2+ years of hands-on experience using CoverMyMeds, specifically in prior authorization processing.
• Strong background in oncology medication access, reimbursement, or patient services.
• Familiarity with specialty pharmacy operations and payer requirements.
• Excellent communication and problem-solving skills.
• Strong attention to detail, organizational skills, and ability to handle multiple cases simultaneously.

Preferred Skills

• Experience working with oncology patient support programs.
• Knowledge of insurance verification, appeals, and reimbursement landscape.
• Ability to work independently while collaborating with cross-functional teams.