Prior Authorization Specialist
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Job Location:
New Haven, CT - USA
Monthly Salary:
Not Disclosed
Posted on:
18 hours ago
Vacancies:
1 Vacancy
Job Summary
Fair Haven Community Health Care
For over 54 years FHCHC has been an innovative and vibrant community health center catering to multiple generations with over 165000 office visits across 21 locations. Guided by a Board of Directors most of whom are patients themselves we take pride in being a healthcare leader dedicated to delivering high-quality affordable medical and dental care to everyone regardless of their insurance status or ability to pay. Our extensive range of primary and specialty care services along with evidence-based programs empowers patients to make informed choices about their health. As we expand our reach to underserved areas our commitment to prioritizing patient needs remains unwavering. FHCHCs mission is to enhance the health and social well-being of the communities we serve through equitable high-quality and culturally responsive patient-centered care.
Job purpose
This role is responsible for prior authorization workflows patient-specific electronic fax management and clinical support within the EPIC EMR ensuring timely accurate coordination across patients providers and clinic staff.
Duties and responsibilities
Reporting to the Pharmacy Outreach Supervisor the Prior Authorization Specialist duties include but are not limited to the following:
- Complete medication and procedural prior authorizations through CoverMyMeds payer portals phone calls and electronic systems.
- Communicate with insurance companies to clarify coverage requirements criteria and documentation needs.
- Collaborate with providers to gather clinical information needed for approvals.
- Communicate with patients regarding prior authorization updates medication issues or required documentation.
- Track follow up and document all authorization statuses to ensure timely patient access to care.
- Assist providers and nurses with prior authorization questions refill coordination and pharmacy communication.
- Monitor organize and route incoming e-faxes to the appropriate clinical team members in EPIC
- Ensure timely processing of forms lab results medication requests and other clinical documents incoming from e-fax
- Support clinic staff with administrative tasks such as scheduling patient outreach and medical record requests.
- Assist in coordinating referrals diagnostic testing and follow-up care.
- Maintain confidentiality and compliance with HIPAA and clinic policies.
- Participate in outreach efforts as directed by the Pharmacy Outreach Supervisor.
High school diploma or GED required Associates Degree preferred. Minimum of 2 years of experience in prior authorizations insurance verification or a related healthcare administrative role required.
Certified Medical Assistant (CMA/RMA) or Pharmacy Technician (CPhT) certification preferred. Bilingual in Spanish and English required.
The ideal candidate will have:
- Familiarity with EPIC
- Strong communication problem-solving and organizational skills.
- Ability to work both independently and collaboratively within a clinical team in a fast operate effectively in a fast-paced environment
- Success in this role requires attention to detail comfort with structured processes and a commitment to supporting reliable patient-centered care.
American with Disabilities Requirements:
External and internal applicants as well as position incumbents who become disabled must be able to perform the essential job specific functions (listed within each job specific responsibility) either unaided or with the assistance of a reasonable accommodation to be determined by the organization on a case by case basis.
Fair Haven Community Health Care is an Equal Opportunity Employer. FHCHC does not discriminate on the basis of race religion color sex age non-disqualifying physical or mental disability national origin veteran status or any other basis covered by appropriate law. All employment is decided on the basis of qualifications merit and business need.
Required Experience:
Junior IC
Key Skills
- Sales Experience
- Crane
- Customer Service
- Communication skills
- Heavy Equipment Operation
- Microsoft Word
- Case Management
- OSHA
- Team Management
- Catheterization
- Microsoft Outlook Calendar
- EHS
About Company
It’s an exciting time for FHCHC. We are growing and looking for great talent to join our team. If you are a passionate, caring professional interested in improving the health of our community, we’d like to know more about you. For nearly 50 years, we have been a health care leader in ... View more
