[Hiring] Prior Authorization Specialist, Data Extraction & AI Quality @Quantile Health
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Role Description
We’re seeking a part-time Prior Authorization (PA) specialist to work with our AI research teams to improve our access agent. This role focuses on identifying patient access gaps and improving model accuracy, and requires hands-on experience interpreting PA requirements in specialty pharmacy, hub services, or utilization management.
This is not a patient-facing role and does not involve submitting PA requests.
Responsibilities
• Review payer PA policy documents for specialty medications.
• Interpret coverage criteria including:
• Step therapy sequences
• Prescriber and site-of-care restrictions
• Translate policy language into standardized, structured data fields.
• Flag ambiguous, conflicting, or unclear policy language.
• Maintain high accuracy and consistency across large document batches.
• Communicate edge cases and clarifications via Slack.
Qualifications
• Bachelors degree, Masters degree in Pharmacy, Pharmacy intern, or PharmD student.
• 1+ years of direct experience interpreting PA requirements in:
• Specialty pharmacy
• Hub services
• Utilization management teams within payer organizations or reimbursement and benefit verification teams.
• Strong familiarity with specialty drugs and biologics.
• Proven ability to interpret payer policy language independently.
• Exceptional attention to detail.
• Comfort with repetitive, structured work.
Requirements
• PharmD (preferred).
• Prior responsibility for PA interpretation or benefit determinations (preferred).
• Experience training or QA’ing other reviewers (preferred).
Benefits
• Fully remote and async-friendly, with the flexibility to work weekends or outside of standard 9–5 hours whenever it fits your schedule.
• Accuracy and turnaround time tracked internally.
• All communication via Slack.
Apply Now
Apply Now
Role Description
We’re seeking a part-time Prior Authorization (PA) specialist to work with our AI research teams to improve our access agent. This role focuses on identifying patient access gaps and improving model accuracy, and requires hands-on experience interpreting PA requirements in specialty pharmacy, hub services, or utilization management.
This is not a patient-facing role and does not involve submitting PA requests.
Responsibilities
• Review payer PA policy documents for specialty medications.
• Interpret coverage criteria including:
• Step therapy sequences
• Prescriber and site-of-care restrictions
• Translate policy language into standardized, structured data fields.
• Flag ambiguous, conflicting, or unclear policy language.
• Maintain high accuracy and consistency across large document batches.
• Communicate edge cases and clarifications via Slack.
Qualifications
• Bachelors degree, Masters degree in Pharmacy, Pharmacy intern, or PharmD student.
• 1+ years of direct experience interpreting PA requirements in:
• Specialty pharmacy
• Hub services
• Utilization management teams within payer organizations or reimbursement and benefit verification teams.
• Strong familiarity with specialty drugs and biologics.
• Proven ability to interpret payer policy language independently.
• Exceptional attention to detail.
• Comfort with repetitive, structured work.
Requirements
• PharmD (preferred).
• Prior responsibility for PA interpretation or benefit determinations (preferred).
• Experience training or QA’ing other reviewers (preferred).
Benefits
• Fully remote and async-friendly, with the flexibility to work weekends or outside of standard 9–5 hours whenever it fits your schedule.
• Accuracy and turnaround time tracked internally.
• All communication via Slack.
Apply Now
Apply Now