Quantile Health

Prior Authorization Specialist, Data Extraction – AI Quality

Quantile Health

part-time

Posted on:

Location Type: Remote

Location: United States

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Salary

💰 $45 per hour

Job Level

Junior

About the role

  • 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

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
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
data interpretationpolicy analysisdocument reviewstructured data translationaccuracy maintenancespecialty pharmacy knowledgeutilization managementpayer policy interpretationreimbursement verification
Soft Skills
attention to detailcommunicationindependenceproblem-solvingclarification of ambiguities
Certifications
Bachelors degreeMasters degreePharmD