Oncology Prior Authorisation Specialist

2 days ago


Shimoga, Karnataka, India beBeePriorAuthorisation Full time ₹ 10,00,000 - ₹ 15,00,000
Job Title: Oncology Prior Authorisation Specialist

This role involves overseeing electronic prior authorizations for oncology-related prescriptions, ensuring timely and accurate processing while collaborating with healthcare providers, insurance companies, and specialty pharmacies to resolve any issues.

Key Responsibilities:

  1. Manage ePA Requests: Process electronic prior authorisations through CoverMyMeds, focusing on oncology medications, and monitor requests to ensure timely follow-up and resolution.
  2. Clinical Documentation Review: Review clinical documentation and verify completeness and accuracy for payer submission.
  3. Issue Resolution: Collaborate with healthcare providers, insurance companies, and specialty pharmacies to resolve prior authorization and reimbursement issues.
  4. Case Management: Manage case activities accurately in CRM or patient management systems.
  5. Process Education: Educate prescribers' offices and staff on CoverMyMeds processes and payer requirements.

Qualifications:

  • Bachelor's degree in a relevant field such as healthcare, pharmacy, life sciences or a related field.
  • At least 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, organisational skills, and ability to handle multiple cases simultaneously.

Preferred Skills:

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


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