Pharmacy Prior Authorization & Specialty-Medication Access Specialist

$75/hrrate as listed

Review AI-generated prior authorization recommendations for specialty drugs, biologics, and high-cost therapies against real payer criteria across commercial, Medicare Part D, and Medicaid plans. Mercor places this work with an AI research lab; observed pay is around $75/hr for experienced PA and specialty access specialists.

Summary, eligibility guidance and screening preparation are prepared by Sidequest from the platform's posting. Check the source listing before applying.

What the work involves

You receive AI-generated outputs — PA determinations, medical-necessity write-ups, appeal letters, formulary lookups, coverage-determination drafts — and judge whether they would actually survive submission to the named payer. That means checking the drug against the correct formulary tier and step-therapy sequence, confirming the clinical documentation cited supports the criteria being claimed, catching hallucinated policy language or invented J-codes, and flagging where the model conflates medical benefit with pharmacy benefit. Much of the task volume involves specialty categories where criteria are dense: oncology, rheumatology, immunology biologics, infusion therapies, and high-cost orphan drugs.

Beyond scoring, you write the correction. Reviewers are expected to explain why an output fails — which criterion was missed, what the payer actually requires, what the appeal or exception pathway should have been — in structured feedback that becomes training signal. Vague ratings without a defensible rationale are the most common reason contributors get rotated off a project.

What the platform screens for

Verifiable operational history. Mercor's screen probes specifics: which PBMs and portals you worked in, typical daily PA volume, your approval and overturn rates, the therapeutic classes you handled most.
Depth under follow-up. Expect the interviewer to push past a general answer into a concrete one — the exact step-therapy sequence for a TNF inhibitor under a commercial plan, or the timeline and evidentiary standard for a Part D expedited coverage determination.
Evaluation judgment. Can you separate "clinically reasonable but non-compliant with this payer's policy" from "factually wrong"? Both matter; they are scored differently.
Written clarity. Feedback quality is graded. Rambling or hedged rationales fail calibration.

Logistics

Fully remote and predominantly async. Contributors typically commit 10–20 hours weekly, self-scheduled, with occasional live calibration sessions in US time zones. Work is contract-based and project-scoped: volume fluctuates with the lab's task pipeline, and continuation depends on maintaining agreement scores against gold-standard reviews. The $75/hr figure reflects observed rates for this listing tier and is not guaranteed — bands shift by assessed depth and project.

What they look for

5+ years in pharmacy prior authorization, specialty medication access, or PBM operations
Working command of specialty drug formularies, step-therapy protocols, and payer-specific PA criteria
Medicare Part D coverage determination, exception, and appeals process fluency
Hands-on experience with PBM systems and specialty pharmacy platforms
Clear, structured written English for annotation rationales
CPhT or CPAP credential (preferred), or specialty pharmacy/infusion/oncology access background

Before you apply

Would you pass this screen?

Drawn from what this listing actually requires. Answered in your browser — nothing is sent to us, and we do not store your answers.

Do you have at least 5 years of professional experience in pharmacy prior authorization, specialty medication access, or pharmacy benefit management?
Pharmacy Prior Authorization Experience · required
Have you worked hands-on with specialty pharmacy or pharmacy benefit management (PBM) systems to process prior authorizations or manage formulary/coverage data?
Specialty Pharmacy Platform Knowledge · required
Are you familiar with Medicare Part D coverage determination and exception processes?
Medicare Part D Familiarity · preferred
Do you hold either a Certified Pharmacy Technician (CPhT) or Certified Prior Authorization Professional (CPAP) credential, or do you have background experience in specialty pharmacy, infusion services, or oncology/rheumatology medication access?
Pharmacy Credential or Specialty Experience · preferred

0 of 4 answered

Included with this listing

Interview prep — 11 questions

Matched to what this platform's screening actually measures. Answer each out loud in 60–90 seconds: claim → concrete example → implication.

What it tests: Whether the candidate has hands-on experience evaluating clinical documentation against payer-specific PA criteria, and can articulate the reasoning process behind approval or denial decisions.
A strong answer: The answer should name a specific medication class (e.g., biologics for rheumatology, specialty oncology drugs) and explain which clinical elements (diagnosis, prior therapy failure, dosing, comorbidities) the candidate matched against the payer's step-therapy or coverage policy to reach a decision.
Where people lose it: Describing PA as a clerical task—checking boxes or just transmitting paperwork—rather than demonstrating judgment about whether clinical evidence supports payer requirements. Vague answers like 'I reviewed the chart and approved it' signal no real understanding of the evaluation process.