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Making transformative medicine accessible to every patient
Prior Authorization Specialist, Data Extraction – AI Quality
Location
United States
Posted
93 days ago
Salary
$45 / hour
Seniority
Junior
Job Description
Prior Authorization Specialist, Data Extraction – AI Quality
Quantile Health
• Review payer PA policy documents for specialty medications. Interpret coverage criteria including: Step therapy sequences, Prescriber and site-of-care restrictions etc • 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
Job Requirements
- 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
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