Remote Pharmacy PA & Specialty Access Specialist

Appsierra Group; United States; On-site; USD 88,000 - 118,000; Part time

Job summary

Appsierra Group in the United States is seeking an experienced Pharmacy Prior Authorization and Specialty Medication Access Specialist for an hourly contract. You will evaluate AI tools designed to automate PBM and PA workflows.

The role requires deep knowledge of formularies, step therapy, payer PA criteria, and Medicare Part D; you will review clinical documentation and coordinate with prescribers and payers. This remote US role offers flex scheduling and weekly payments.

Qualifications

• 5+ years of experience in pharmacy prior authorization, specialty medication access, or PBM.
• Deep knowledge of specialty drug formularies and payer PA criteria across commercial and government payers.
• Experience with specialty pharmacy platforms and PBM systems.
• Familiarity with Medicare Part D coverage determination and exception processes.
• Excellent written and verbal English communication skills.
• High attention to detail when evaluating clinical docs and AI outputs.

Responsibilities

• Process and manage prior authorization requests for specialty meds across payers.
• Review clinical documentation to determine medical necessity for PA.
• Evaluate AI-generated PA recommendations for accuracy and payer compliance.
• Coordinate with prescribers, specialty pharmacies, and payers for authorizations.
• Manage appeals for denied authorizations, including peer-to-peer and exceptions.
• Navigate formularies and step therapy requirements.
• Track authorization status, approval rates, denial trends; identify process improvements.
• Ensure compliance with CMS Part D guidelines.
• Annotate AI outputs to support AI training datasets.

Skills

Prior Authorization

PBM systems

Medicare Part D

Clinical documentation review

English communication

Attention to detail

Job description

Appsierra Group in the United States is seeking an experienced Pharmacy Prior Authorization and Specialty Medication Access Specialist for an hourly contract. You will evaluate AI tools designed to automate PBM and PA workflows.

The role requires deep knowledge of formularies, step therapy, payer PA criteria, and Medicare Part D; you will review clinical documentation and coordinate with prescribers and payers. This remote US role offers flex scheduling and weekly payments.