01Overview
Job Summary Prior Authorization Specialist (Cover MyMeds)
- Process end-to-end medication and prescription prior authorization (PA) requests, managing 30 70+ cases daily.
- Submit accurate PA requests via Cover MyMeds and payer portals, ensuring compliance with insurance and formulary requirements.
- Verify patient insurance eligibility, benefits, and authorization criteria for each request.
- Collect, review, and organize required clinical documentation (diagnosis, notes, lab results, medication history).
- Communicate and coordinate with providers, pharmacies, payers, and internal teams to resolve PA issues.
- Manage denials, resubmissions, appeals, and additional documentation requests.
- Follow up with payers to track status and ensure timely completion of authorizations.
- Maintain exact documentation of all authorization activities and adhere to turnaround standards.
- Utilize EMR/EHR systems (e.g., Epic, Athenahealth, eClinical Works) for processing and documentation.
- Handle high-volume PA workflows efficiently while maintaining accuracy and quality.
- Work night shifts based in Hyderabad.
Preferred Experience:
- Prior authorizations in multiple specialties (Rheumatology, Gastroenterology, Urology, ENT/Allergy).
- Exposure to specialty medications, biologics, and specialty pharmacy workflows.
- Familiarity with payer portals and complex medication authorization requirements.
Note: Minimum 3 years of PA experience and proficiency with Cover MyMeds required. Freshers not eligible. Strong English communication skills essential. .
