Medication Access Specialist: AI-Driven Prior Authorisation

Obsidian; New York (NY); Remote; USD 90,000 - 130,000; Full time

Job summary

Mercor is partnering with a leading AI research lab to advance pharmacy benefit management and prior authorisation workflows. We are seeking experienced Medication and Pharmacy Prior Authorisation specialists who understand specialty medication access and payer criteria.

You will evaluate AI-generated recommendations, coordinate with prescribers and payers, and ensure compliance with CMS Part D rules while annotating outputs to improve training datasets.

Qualifications

• 5+ years of experience in pharmacy prior authorisation or PBM.
• Deep knowledge of speciality drug formularies and step therapy 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.

Responsibilities

• Process and manage prior authorisation requests for speciality medications across payers.
• Review clinical documentation and PBM criteria for medical necessity.
• Evaluate AI-generated PA recommendations for accuracy and payer compliance.
• Coordinate with prescribers, speciality pharmacies, and payers for timely authorisations.
• Manage appeals for denied authorisations, including peer-to-peer requests.
• Navigate payer formulary, step therapy, and specialty drug coverage policies.
• Track authorisation status, approval rates, and denial trends for process improvements.
• Annotate AI outputs and provide structured feedback for AI training datasets.

Skills

Pharmacy prior authorisation

Speciality medication access

Payer criteria knowledge

English communication

Tools

PBM systems

Speciality pharmacy platforms

Job description

Mercor is partnering with a leading AI research lab to advance pharmacy benefit management and prior authorisation workflows. We are seeking experienced Medication and Pharmacy Prior Authorisation specialists who understand specialty medication access and payer criteria.

You will evaluate AI-generated recommendations, coordinate with prescribers and payers, and ensure compliance with CMS Part D rules while annotating outputs to improve training datasets.