Infusion Pharmacy Authorization

Key Responsibilities

• Prior Authorization & Intake Coordination: Review new specialty infusion referrals. Gather, prepare, and submit complete PA requests via electronic portals (e.g., CoverMyMeds), fax, or phone.
• Insurance Benefit Investigation: Verify patient-specific coverage, co-pays, deductibles, step-therapy requirements, and formulary restrictions across both medical and pharmacy benefit structures.
• Clinical Review Assistance: Analyze patient charts, lab results, and nursing documentation to ensure all clinical criteria required by the payer are met before submission.
• Denial & Appeal Management: Navigate insurance rejections and peer-to-peer review requirements. Coordinate closely with clinical teams to compile and submit appeals when necessary.
• Patient & Provider Communication: Keep patients informed regarding their approval timelines, coverage details, and out-of-pocket costs. Provide status updates to clinical coordinators and physicians.
• Electronic Health Records (EHR) Documentation: Maintain meticulous, up-to-date documentation of PA status, authorization numbers, expiration dates, and payer interactions in systems like Epic or custom pharmacy management tools. [1, 2]
• Financial Advocacy Support: Identify opportunities for drug manufacturer co-pay cards, foundation grants, or financial assistance programs to minimize the patient's out-of-pocket burden

Pay: ₹23,000.00 - ₹35,000.00 per hour

Benefits:

• Flexible schedule
• Provident Fund

Work Location: In person