Oncology Prior Authorization Specialist

About RISA LabsCancer patients face not just a disease, but a broken system where delays in treatment arecommon due to outdated, error-prone workflows. RISA Labs is changing that with our BusinessOperating System as a Service (BOSS) - a powerful platform built for the vertical complexity ofhealthcare, that transforms healthcare operations. Unlike simple automation tools, BOSS breaksdown complex workflows into small tasks, managed by smart AI agents like LLMs, digital twins,and reinforcement learners. This creates a digital workforce that doubles the efficiency ofhealthcare teams, letting a 1,000-person institution operate like it has 2,000 staff overnight.FoundersRISA was founded by Kshitij Jaggi and Kumar Shivang, IIT Kanpur alumni with a proven trackrecord from their previous healthcare startup, Urban Health. Their vision is to streamlineoncology care through cutting-edge technology.FundingRISA Labs is backed by $3.5 million in seed funding, led by Flipkart co-founder Binny Bansal,with support from Oncology Ventures, General Catalyst, z21 Ventures, Odd Bird VC, and angelinvestor Ashish Gupta.Role OverviewWe are seeking a detail-oriented Oncology Prior Authorization Specialist to manage andstreamline the prior authorization (PA) process for oncology treatments and procedures. In thisrole, you will ensure timely and accurate approvals while maintaining compliance with insuranceguidelines. You will collaborate with oncologists, nursing staff, billing teams, and insurancepayers to facilitate access to necessary oncology care and remove barriers to treatment.ResponsibilitiesManage Prior Authorization Process: Oversee the entire prior authorization process for oncology treatments, procedures, and medications, ensuring timely and efficient approvalsReview Requests: Evaluate prior authorization requests to confirm they meet medical necessity criteria and payer guidelinesCollaborate with Care Teams: Work closely with oncologists, nursing staff, and billing teams to gather necessary clinical documentation and ensure it is submitted accurately and promptlyInsurance Coordination: Coordinate with insurance companies to resolve coverage issues, denials, and appeals, ensuring that patients receive the care they need without unnecessary delaysRecord Keeping: Maintain accurate records of all prior authorization requests, including approvals, denials, and appeals, ensuring documentation is compliant and well-organizedProactive Problem Resolution: Identify and address barriers to timely approvals, proactively addressing payer-specific requirements and facilitating smoother workflowsPolicy & Guideline Updates: Stay informed on insurance policy changes, payer guidelines, and new oncology treatments to ensure compliance and accurate processing of requestsProvide Feedback & Insights: Support oncology care teams by offering feedback to improve the prior authorization workflow and streamline operational efficiencyUtilize Technology: Use electronic medical records (EMR) systems (e.g., OncoEMR) and prior authorization platforms to manage and streamline processesCompliance: Ensure all communications and documentation comply with HIPAA and other relevant regulatory standardsQualificationsExperience: Minimum of 3 years of experience managing medical prior authorizations, specifically within oncologyPreferred Experience: Experience working in a cancer center or with oncology clients is highly preferredKnowledge: In-depth understanding of oncology treatments, procedures, and insurance requirements for medical prior authorizationsInsurance & Reimbursement: Strong understanding of insurance policies, reimbursement processes, and medical necessity criteria for oncology careTechnical Proficiency: Proficient in EMR systems (e.g., OncoEMR or similar platforms) and multiple payer portals, plans, and prior authorization toolsCommunication Skills: Excellent communication and interpersonal skills, with the ability to effectively liaise between healthcare teams, patients, and insurance payersDetail-Oriented: Ability to maintain accurate and organized documentation in a fast-paced environmentCollaboration & Independence: Ability to work independently and collaboratively with care teams in a dynamic oncology care settingCompliance Knowledge: Strong knowledge of HIPAA compliance and other regulatory standardsPreferred Certifications: Certification in Medical Coding, Healthcare Administration, or a related field is a plus