Oncology Prior Authorization Specialist

6 days ago

Davangere, Karnataka, India beBeeOncology Full time ₹ 14,00,000 - ₹ 22,00,000

Job Title: Oncology Prior Authorization Specialist

The role of Oncology Prior Authorization Specialist is a challenging and rewarding position that requires strong clinical knowledge, excellent communication skills, and the ability to work independently in a fast-paced environment.

Responsibilities:

  • Manage and process electronic prior authorizations (e PAs) through Cover My Meds, 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 Cover My Meds 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 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 Cover My Meds, 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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