Remote Medical Prior Authorization Specialist

Global Medical Virtual Assistants; Quezon City; Hybrid; PHP 563,000 - 703,000; Full time

Benefits offered by this job

Free Training

Paid Time Offs

HMO Coverage

Optical Rewards

Performance-Based Increase

Permanent Work From Home

Job summary

Global Medical Virtual Assistants is seeking a Medical Virtual Assistant – Prior Authorization Specialist to manage the end-to-end prior authorization process for healthcare practitioners. You will liaise with providers, insurance companies, and patients to secure timely approvals for procedures, medications, diagnostic tests, and referrals.

You will follow HIPAA guidelines, verify coverage, track requests, and handle denials with the care team's guidance.

Qualifications

• Minimum of 6 months to 1 year of prior authorization or healthcare BPO experience handling US healthcare accounts.
• Strong familiarity with insurance portals, EMR/EHR systems, and medical terminology.
• HIPAA Certification is a plus
• Excellent time management
• Strong attention to detail
• Computer savvy
• Great work attitude and willingness to go the extra mile
• Open to working night shifts

Responsibilities

• Submitting, tracking, and following up on prior authorization requests.
• Managing inbound and outbound calls with healthcare insurance companies to verify authorization requirements, check status updates, and resolve pending or denied requests.
• Verifying patient healthcare insurance coverage, benefits, and specific plan requirements prior to scheduling procedures or submitting authorizations.
• Retrieving relevant medical history, clinical notes, and diagnostic reports.
• Acting as the primary point of contact between medical providers, patients, and payors.
• Identifying reasons for authorization denials, gathering missing clinical information, and preparing basic appeal packages under the direction of healthcare providers.
• Providing specialized back-office support, including data entry, email management, authorization tracking log maintenance, and record management.
• Strictly adhering to HIPAA regulations and maintaining confidentiality across all patient data, insurance details, and communications.

Skills

US healthcare accounts

Insurance portals

EMR/EHR systems

Medical terminology

HIPAA knowledge

Time management

Attention to detail

Computer literacy

Job description

Global Medical Virtual Assistants is seeking a Medical Virtual Assistant – Prior Authorization Specialist to manage the end-to-end prior authorization process for healthcare practitioners. You will liaise with providers, insurance companies, and patients to secure timely approvals for procedures, medications, diagnostic tests, and referrals.

You will follow HIPAA guidelines, verify coverage, track requests, and handle denials with the care team's guidance.