Pharmacy Prior Authorization & Specialty-Medication Access Specialist

Official role description

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.