AI-Powered Medication Access Specialist

Mercor; Houston (TX); On-site; USD 110,000 - 190,000; Full time

Job summary

Mercor is collaborating with a leading AI research lab to advance AI-driven pharmacy benefit management and prior authorisation workflows. We seek experienced Medication and Pharmacy Prior Authorisation specialists with expertise in speciality medication access to evaluate AI tools designed to automate payer processes.

Join a team dedicated to improving patient access to high-cost therapies, working with prescribers, payers, and PBMs, and ensuring CMS Part D compliance.

Qualifications

• 5+ years of experience in pharmacy prior authorisation, speciality medication access, or PBM.
• Deep knowledge of speciality drug formularies, step therapy, and payer PA criteria across commercial and government payers.
• Experience with speciality pharmacy platforms and 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.

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 formulary, 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.

Skills

Pharmacy PBM knowledge

Prior authorisation

Payer criteria

Clinical documentation review

Medical necessity evaluation

AI tools evaluation

English communication

Job description

Mercor is collaborating with a leading AI research lab to advance AI-driven pharmacy benefit management and prior authorisation workflows. We seek experienced Medication and Pharmacy Prior Authorisation specialists with expertise in speciality medication access to evaluate AI tools designed to automate payer processes.

Join a team dedicated to improving patient access to high-cost therapies, working with prescribers, payers, and PBMs, and ensuring CMS Part D compliance.