Oncology Prior Authorisation

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).

1+ 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.