Prior Authorization Specialist

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 165,000 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. FHCHC's 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.

Qualifications

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.