
Electronic Prior Authorisation Specialist
1 week ago
As a specialist in electronic prior authorizations, you will play a pivotal role in 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.
You will be responsible for managing electronic prior authorizations through CoverMyMeds, focusing on oncology medications. This involves reviewing clinical documentation to ensure completeness and accuracy for payer submission, as well as collaborating with healthcare providers to resolve prior authorization and reimbursement issues.
Additionally, you will need to stay updated on oncology drug access pathways, insurance policies, and payer-specific rules. Your excellent communication and problem-solving skills will be essential in educating prescribers' offices and staff on CoverMyMeds processes and payer requirements.
What You Will Do\- \
- Manage ePAs: Process electronic prior authorizations through CoverMyMeds, focusing on oncology medications\
- Review Clinical Documentation: Ensure completeness and accuracy for payer submission\
- Collaborate with Healthcare Providers: Resolve prior authorization and reimbursement issues with healthcare providers, insurance companies, and specialty pharmacies\
- Monitor and Track Requests: Ensure timely follow-up and resolution of prior authorization requests\
- Educate Prescribers: Educate prescribers' offices and staff on CoverMyMeds processes and payer requirements\
- Stay Updated: Stay updated on oncology drug access pathways, insurance policies, and payer-specific rules\
- Document Case Activities: Document case activities accurately in CRM or patient management systems\
- Support Patient Access Initiatives: Work cross-functionally with internal teams to support patient access initiatives\
- Experience Working with Oncology Patient Support Programs: Opportunity to work with oncology patient support programs\
- Knowledge of Insurance Verification, Appeals, and Reimbursement Landscape: In-depth knowledge of the insurance verification, appeals, and reimbursement landscape\
- Ability to Work Independently: Ability to work independently while collaborating with cross-functional teams
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