Prior Authorization Specialist, Data Extraction & AI Quality (Fully Remote, Part-Time)
About The Position
Quantile Health is a New York-based, fast growing AI agent startup on a mission to expand patient access to life-changing medicines while cutting commercial research costs for the life science industry. 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.
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
Nice To Haves
- PharmD
- Prior responsibility for PA interpretation or benefit determinations
- Experience training or QA’ing other reviewers
Responsibilities
- 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
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What This Job Offers
Job Type
Part-time
Career Level
Entry Level
