What are the responsibilities and job description for the Prior Authorization Specialist position at Pennyroyal Healthcare Services DBA Community...?
Job Title: Prior Authorization Specialist (Medical Assistant Background Required)
Position Summary
The Prior Authorization Specialist is responsible for obtaining and managing insurance prior authorizations for medications within a Federally Qualified Health Center (FQHC) setting. This role ensures timely approvals to support continuity of care for a diverse and underserved patient population. The position leverages clinical knowledge and administrative skills typically gained from a Medical Assistant background.
Key Responsibilities
- Submit Medication prior authorization requests to insurance companies and/or Cover my Meds(Medicaid, Medicare, and commercial payers)
- Track and follow up on authorization requests to ensure timely approvals
- Communicate authorization status to providers, clinical staff, and patients
- Obtain and document all required clinical information to support authorization requests
- Coordinate with providers to gather additional documentation when needed
- Handle denials by initiating appeals and providing supporting documentation
- Maintain accurate records in the Electronic Health Record (EHR) system
- Ensure compliance with FQHC regulations, payer guidelines, and HIPAA requirements
- Support quality improvement initiatives related to access to care and authorization turnaround times
Required Qualifications
- High School Diploma or GED required
- Completion of a Medical Assistant program
- Current Medical Assistant certification (CMA, RMA, or equivalent)
- Minimum 1–2 years of experience in a clinical or healthcare administrative role
- Knowledge of medical terminology, procedures, and basic clinical workflows
- Familiarity with insurance plans, including Medicaid and Medicare
Pay: From $17.00 per hour
Benefits:
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Work Location: In person
Salary : $17