Pharmacy Documentation Reviewer at Mercor

Pharmacy Documentation Reviewer | $60–115/hr | Remote in US

Join a leading AI lab focused on transforming healthcare access by streamlining payer authorizations and reducing delays in specialty treatments. This role is ideal for professionals experienced in infusions and specialty pharmacy documentation review who want to make a real impact in healthcare technology.

• Review and validate AI-generated clinical determinations for accuracy and compliance with payer coverage policies.
• Analyze and interpret insurance policies, including Medicare, Medicaid, and commercial payers, to ensure proper application of medical necessity criteria.
• Provide structured feedback on unclear or incorrect determinations to improve AI decision-making standards.
• Collaborate with AI and product teams to refine workflows and enhance review processes.
• Maintain clear records and contribute to ongoing process improvements.

Qualifications:

• Hands-on experience in infusions or specialty pharmacy (intake, documentation review, case management, or clinical review).
• Strong understanding of payer requirements and compliance standards.
• Ability to interpret and apply insurance coverage policies to clinical scenarios.
• Detail-oriented, organized, and confident in policy-based decision making.
• Comfortable working independently in a remote environment.

Preferred: 4+ years in infusions/SP, familiarity with Medicare/Medicaid/commercial guidelines, knowledge of HCPCS codes and infusion drug categories, prior authorization or audit experience, and comfort using AI tools.

Enjoy flexible remote work (20–30 hrs/week) while applying your expertise to innovative healthcare solutions and collaborating with a high-caliber global team.