Remote Medical Prior Auth & Insurance Coordinator

Go Lean Health; Mandaluyong; A distancia; PHP 440.000 - 527.000; Jornada completa

Descripción de la vacante

Go Lean Health is seeking a Medical Virtual Assistant to support a busy U.S. medical practice from a remote setting in the Philippines.

The role focuses on prior authorization, insurance coordination, and patient communication, ensuring timely, accurate submissions and effective follow-up. The ideal candidate will manage authorizations, review medical records, and maintain HIPAA-compliant patient documentation in Athenahealth, while communicating clearly with patients and insurance

Formación

• Hands-on experience using Athenahealth (Athena) is mandatory.
• Hands-on experience using CoverMyMeds for medication prior authorization is mandatory.
• Proven experience independently preparing, submitting, tracking, and following up on medication prior authorization requests.
• Previous experience supporting a U.S. healthcare practice in medical administration, insurance coordination, or clinical support.
• Working knowledge of U.S. health insurance processes, pharmacy benefits, Medicare, Medicare Advantage, and HMO authorization requirements.
• Ability to interpret clinical notes, diagnoses, ICD-10 codes, medication histories, and insurance documentation requirements accurately.

Responsabilidades

• Initiate, submit, track, and follow up on medication prior authorizations using CoverMyMeds.
• Process authorizations for GLP-1 and weight-management medications, ADHD medications, hormonal treatments, and other prescriptions requiring insurance approval.
• Review clinical documentation, diagnoses, ICD-10 codes, medication histories, and payer requirements to ensure accurate submissions.
• Navigate insurance portals, including Availity, to verify requirements and obtain authorization approvals.
• Monitor pending requests, coordinate missing documentation, and elevate denials or clinical questions to the appropriate provider.

Conocimientos

Athenahealth experience

CoverMyMeds experience

Insurance coordination

Medical administration

English communication

Herramientas

Athenahealth

CoverMyMeds

Descripción del empleo

Go Lean Health is seeking a Medical Virtual Assistant to support a busy U.S. medical practice from a remote setting in the Philippines.

The role focuses on prior authorization, insurance coordination, and patient communication, ensuring timely, accurate submissions and effective follow-up. The ideal candidate will manage authorizations, review medical records, and maintain HIPAA-compliant patient documentation in Athenahealth, while communicating clearly with patients and insurance