Oncology Prior Authorisation
1 week ago
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.
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