Prior Authorization Specialist CoverMyMeds (India)

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. .