Pharmacy Prior Authorization & Specialty-Medication Access Specialist
Mercor • Remote
Education
Any
Type
hourly
Pay Rate
$75/hr
Listed
34d ago
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About this Role
From the Mercor listing
Mercor is working with a leading AI research lab to improve the capabilities of next-generation AI systems. We are seeking experienced Medication and Pharmacy Prior Authorisation specialists with expertise in speciality medication access to evaluate AI tools designed to automate pharmacy benefit management and speciality drug authorisation workflows. Your deep knowledge of drug formularies, step therapy, and payer PA criteria will directly shape AI systems that improve patient access to critical therapies.
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.
Navigate payer formularies, step therapy requirements, and speciality drug coverage policies.
Track authorisation 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 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 Qualifications
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.
Why Join?
Contribute to the development of frontier AI systems in healthcare.
Collaborate with a world-class AI research organisation.
Gain exposure to cutting-edge AI workflows in healthcare revenue cycle management.
Opportunity to work on high-impact projects shaping the future of healthcare AI.
Requirements
- Must be eligible to work in Remote
- Fluent proficiency in English (Written & Verbal)
- Reliable high-speed internet connection
- Bachelor's degree or equivalent professional experience
- Demonstrated expertise in Healthcare
- Valid professional license (MD, DO, RN, etc.)
- Current knowledge of medical standards and practices
Eligible Languages
Fluent proficiency in English
Why This Role
No office, no fixed hours, no relocation. This Pharmacy Prior Authorization & Specialty-Medication Access Specialist role pays $75/hr fully remote, giving you access to Healthcare work that would otherwise be limited to a handful of major cities.
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Frequently Asked Questions
Is Mercor for freelancers or full-time contractors?
Mercor places you with one client for a defined engagement, like 'Python Tutor for 3 months', rather than having you grab small tasks from a shared queue. Most roles function as steady contract work, not one-off gigs.
Does Mercor's application require an on-camera interview?
Yes, every applicant records a video interview with an AI interviewer that asks questions about your resume. Clients review that recording to judge communication skills before matching, so there's no way to apply without going on camera.
Does it cost money to apply to Mercor?
No, applying and joining Mercor is free. Mercor's revenue comes from a fee it charges the client on top of your hourly rate, not from applicants. Treat any request for payment to join as a red flag.
What does task-based AI training work actually look like?
Practical, hands-on data work: recording short videos, categorizing images, rating text responses, or analyzing data. Tasks are designed to be short and distinct, typically 5 to 60 minutes each.
What does asynchronous AI training work mean in practice?
No set hours, no check-ins, no meetings. You log in when you want, pick up an available task, complete it, and submit; nobody is waiting on you in real time. That's different from remote employment, where you're expected online during business hours. The tradeoff: you're competing with others for available tasks, so an empty queue means there's simply nothing to do until more work is released.
What does Healthcare work look like for a Pharmacy Prior Authorization & Specialty-Medication Access Specialist?
Tasks here are scoped to Healthcare, not generic labeling. As a Pharmacy Prior Authorization & Specialty-Medication Access Specialist, expect to draw on real domain judgment (evaluating outputs, correcting errors, or providing expert reasoning specific to Healthcare) rather than following a one-size-fits-all rubric. If you don't have hands-on Healthcare background, this is likely not the right listing to start with.
Do I need to be fluent in English?
Yes. This role specifically requires English proficiency. You will likely be evaluated on written fluency during the assessment, not just conversational level. If English is not your first language or you are not professionally fluent, this is not the right role. Filter for your native language to find better-matched listings.
What happens when I click Apply on this listing?
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How soon will I start working after applying to Mercor?
Not immediately. Mercor is a talent marketplace, not a task queue, so applying puts you in a pool of candidates. You start working only once a specific client, like a major AI lab, selects your profile, and that matching process can take weeks.