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Job description
About the job
Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark, General Catalyst, Peter Thiel, Adam D'Angelo, Larry Summers, and Jack Dorsey.
Position: Pharmacy Prior Authorization & Specialty-Medication Access Specialist
Type:Contract
Compensation:$75/hour
Location:Remote
Role Responsibilities
Process and manage prior authorisation requests for speciality 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 speciality drug authorisations.
Evaluate AI-generated pharmacy prior authorisation recommendations for accuracy, completeness, and payer compliance.
Coordinate with prescribers, speciality pharmacies, and payers to obtain timely medication authorisations.
Manage appeals for denied pharmacy authorisations, including peer-to-peer requests and exception processes.
Annotate AI outputs and provide structured feedback to support AI training datasets.
Qualifications
Must-Have
5+ years of experience in pharmacy prior authorisation, speciality medication access, or pharmacy benefit management.
Deep knowledge of speciality drug formularies, step therapy protocols, and payer PA criteria across commercial and government payers.
Experience with speciality 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
Certified Pharmacy Technician (CPhT) or Certified Prior Authorisation Professional (CPAP) credential.
Experience with hub services and patient assistance programs for speciality medications.
Background in speciality 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.
Application Process (Takes 20–30 mins to complete)
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Resources & Support
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PS: Our team reviews applications daily. Please complete your AI interview and application steps to be considered for this opportunity.
Originally posted on Himalayas
Who can apply
Eligible countries: United States. Accepted UTC offsets: UTC-10, UTC-9, UTC-8, UTC-7, UTC-6, UTC-5, UTC+14. Review the full description for employer-specific work authorization, residency and schedule requirements.