[Hiring] Pharmacy PA Specialist - Expert @Mercor

Role Description

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.
• Annotate AI outputs and provide structured feedback to support AI training datasets.

Qualifications

• 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.

Requirements

• Certified Pharmacy Technician (CPhT) or Certified Prior Authorisation Professional (CPAP) credential (preferred).
• Experience with hub services and patient assistance programs for speciality medications (preferred).
• Background in speciality pharmacy, infusion services, or oncology/rheumatology drug access (preferred).
• Familiarity with AI tools and comfort evaluating AI-generated pharmacy content (preferred).
• Experience with manufacturer copay assistance and patient access programs (preferred).

Benefits

• Compensation: $75/hour
• Type: Contract
• Location: Remote

Application Process

• Upload resume
• AI interview based on your resume
• Submit form

Resources & Support

• For details about the interview process and platform information, please check: Interview Process
• For any help or support, reach out to: [email protected]
• PS: Our team reviews applications daily. Please complete your AI interview and application steps to be considered for this opportunity.