Seeking experienced patient financial services leaders to evaluate healthcare AI systems, improve self-pay collections, optimize patient payment plans, enhance financial engagement, and maximize revenue recovery while maintaining compliance and patient satisfaction.
Pharmacy Prior Authorization & Specialty-Medication Access Specialist
United States
$75 – $75/hr
June 24, 2026
Job description
Role Overview
Mercor is partnering with a leading AI research laboratory to improve next-generation AI systems used in healthcare and pharmacy benefit management.
The organization is seeking experienced Pharmacy Prior Authorization and Specialty Medication Access Specialists to evaluate and improve AI tools designed to automate specialty drug authorization workflows, pharmacy benefit management processes, and medication access operations.
Responsibilities
Pharmacy Prior Authorization Management
- Process and manage prior authorization requests for specialty medications, biologics, and high-cost pharmaceuticals
- Support authorization workflows across commercial payers, Medicare Part D, and Medicaid plans
Clinical & Pharmacy Review
- Review clinical documentation and pharmacy benefit requirements
- Assess medical necessity and payer eligibility criteria
AI Evaluation & Quality Review
- Evaluate AI-generated pharmacy prior authorization recommendations for accuracy, completeness, clinical appropriateness, and payer compliance
- Annotate AI outputs and provide structured feedback to support AI training datasets
Formulary & Coverage Navigation
- Navigate drug formularies, step therapy requirements, and specialty drug coverage policies
- Identify coverage barriers and access solutions
Requirements
- 5+ years of experience in Pharmacy Prior Authorization, Specialty Medication Access, or Pharmacy Benefit Management (PBM)
- Strong knowledge of specialty drug formularies, step therapy protocols, and prior authorization criteria
- Familiarity with Medicare Part D coverage determinations and exception/appeal processes
Preferred Qualifications
- Certified Pharmacy Technician (CPhT) or Certified Prior Authorization Professional (CPAP)
- Experience with hub services, patient assistance programs, or oncology/rheumatology medication access
Contract & Payment Terms
- Independent contractor engagement · Fully remote · Flexible schedule
- Weekly payments through Stripe or Wise
- US work authorization required · No visa sponsorship
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