Pharmacy Prior Auth & Specialty Access at Mercor

Pharmacy Prior Auth & Specialty Medication Access Specialist | $75/hr | Worldwide Remote

Mercor is partnering with a leading AI research lab to recruit experienced Pharmacy Prior Authorization and Specialty Medication Access Specialists. In this role, you will evaluate and provide expert feedback on AI tools designed to automate pharmacy benefit management and specialty drug authorization workflows — directly shaping the next generation of healthcare AI.

Key Responsibilities

• Process and manage prior authorization (PA) requests for specialty medications, biologics, and high-cost pharmaceuticals across commercial, Medicare Part D, and Medicaid payers.
• Review clinical documentation and pharmacy benefit criteria to determine medical necessity for specialty drug authorizations.
• Evaluate AI-generated pharmacy PA recommendations for accuracy, completeness, and payer compliance.
• Coordinate with prescribers, specialty pharmacies, and payers to secure timely medication authorizations.
• Manage appeals for denied pharmacy authorizations, including peer-to-peer requests and exception processes.
• Navigate payer formularies, step therapy requirements, and specialty drug coverage policies.
• Track authorization status, approval rates, and denial trends to identify process improvement opportunities.
• Ensure compliance with payer-specific pharmacy benefit requirements and CMS Part D guidelines.
• Annotate AI outputs and provide structured feedback to support AI training datasets.

Requirements

• 5+ years of experience in pharmacy prior authorization, specialty medication access, or pharmacy benefit management.
• Deep knowledge of specialty drug formularies, step therapy protocols, and payer PA criteria across commercial and government payers.
• Experience with specialty pharmacy platforms and pharmacy benefit management (PBM) systems.
• Familiarity with Medicare Part D coverage determination and exception processes.
• Exceptional written and verbal English communication skills.
• High attention to detail with the ability to evaluate clinical documentation and AI-generated outputs.

Preferred Qualifications

• Certified Pharmacy Technician (CPhT) or Certified Prior Authorization Professional (CPAP) credential.
• Experience with hub services and patient assistance programs for specialty medications.
• Background in specialty pharmacy, infusion services, or oncology/rheumatology drug access.
• Familiarity with AI tools and comfort evaluating AI-generated pharmacy content.
• Experience with manufacturer copay assistance and patient access programs.

Why Join?

• Contribute to the development of frontier AI systems in healthcare.
• Collaborate with a world-class AI research organization.
• Gain exposure to cutting-edge AI workflows in healthcare revenue cycle management.
• Work on high-impact projects shaping the future of healthcare AI.