Medication Access AI Trainer: Prior Authorization Expert

Obsidian; Houston (TX); On-site; USD 90,000 - 130,000; Full time

Job summary

Mercor is collaborating with a leading AI research lab to optimize pharmacy prior authorisation workflows for speciality medications across commercial and government payers. The role focuses on reviewing PA criteria, ensuring medical necessity, and supporting AI-driven decision tools.

Candidates should have 5+ years in pharmacy PA or PBM roles, strong English communication, and familiarity with Medicare Part D processes. The position emphasizes collaboration with prescribers, PBMs, and AI teams.

Qualifications

• 5+ years of pharmacy prior authorisation, speciality medication access, or PBM experience.
• Deep knowledge of speciality drug formularies, step therapy protocols, 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 ability to evaluate clinical documentation and AI-generated outputs.

Responsibilities

• Process and manage prior authorisation requests for speciality medications across commercial, Medicare Part D, and Medicaid payers.
• Review clinical documentation and payer 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 PA knowledge

PBM systems

Medicare Part D familiarity

Job description

Mercor is collaborating with a leading AI research lab to optimize pharmacy prior authorisation workflows for speciality medications across commercial and government payers. The role focuses on reviewing PA criteria, ensuring medical necessity, and supporting AI-driven decision tools.

Candidates should have 5+ years in pharmacy PA or PBM roles, strong English communication, and familiarity with Medicare Part D processes. The position emphasizes collaboration with prescribers, PBMs, and AI teams.