Prior Authorization Specialist

1 week ago

Nashik, Maharashtra, India beBeeOncology Full time ₹ 10,26,523 - ₹ 13,72,167

Job Overview:

This role is responsible for the efficient and timely processing of electronic prior authorizations (ePAs) related to oncology medications. The specialist will collaborate closely with prescribers, pharmacies, and payers to ensure streamlined access to critical treatments.

Key Responsibilities:

  • Manage and process ePAs through CoverMyMeds, focusing on oncology drugs.
  • Review clinical documentation for completeness and accuracy before payer submission.
  • Collaborate with healthcare providers and insurance companies to resolve authorization and reimbursement issues.
  • Monitor and track prior authorization requests for timely follow-up and resolution.
  • Educate prescribers' offices on CoverMyMeds processes and payer requirements.
  • Stay updated on oncology drug access pathways, insurance policies, and payer rules.
  • Document case activities accurately in CRM or patient management systems.
  • Support internal teams to enhance patient access initiatives.

Qualifications:

  • Bachelor's degree in a relevant field (e.g., healthcare, pharmacy, life sciences).
  • 2+ years of hands-on experience using CoverMyMeds for 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 and collaboratively within cross-functional teams.

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