Remote Medical VA: Prior Auth & Insurance Support

Go Lean Health; Davao City; Remote; PHP 440,000 - 527,000; Full time

Job summary

Go Lean Health is seeking an experienced Medical Virtual Assistant to support a U.S. medical practice from a remote setting.

The role focuses on prior authorization, insurance coordination, and patient communication with emphasis on HIPAA-compliant documentation. You will independently manage authorization requests in Athenahealth and CoverMyMeds, verify payer requirements, and maintain accurate records, while providing proactive patient outreach and timely case resolution.

Qualifications

• 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.

Responsibilities

• 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.
• Handle Medicare GLP-1 Bridge requests and specialist visit authorizations for HMO and Medicare Advantage plans.
• 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.
• Initiate new authorization requests ideally within 24 hours of patient visits and proactively manage outstanding cases.
• Manage inbound patient calls, voicemails, and outbound communications with patients, pharmacies, insurance companies, and healthcare providers.
• Conduct outbound calls for appointment scheduling, including Annual Wellness Exams, and other follow-up needs.
• Coordinate specialist referrals, insurance approvals, and medical records requests with external healthcare facilities.
• Independently manage the patient phone queue during designated coverage periods.
• Provide clear, professional communication while escalating clinical concerns to the appropriate healthcare professional.
• Maintain accurate and timely patient records, authorization updates, and follow-up documentation using Athenahealth (Athena).
• Track authorization submissions, approvals, denials, expiration dates, and pending actions.
• Request and process medical records from primary care providers, specialists, laboratories, imaging centers, and other authorized parties.
• Take ownership of assigned cases, working toward resolution within 72 hours whenever possible.
• Coordinate with clinical staff to resolve outstanding requests, prioritize urgent tasks, and maintain continuity of patient care.
• Ensure all activities comply with HIPAA requirements and established practice procedures.

Skills

Prior authorization

Insurance coordination

Patient communication

Medical administration

Tools

Athenahealth

CoverMyMeds

Availity

Job description

Go Lean Health is seeking an experienced Medical Virtual Assistant to support a U.S. medical practice from a remote setting.

The role focuses on prior authorization, insurance coordination, and patient communication with emphasis on HIPAA-compliant documentation. You will independently manage authorization requests in Athenahealth and CoverMyMeds, verify payer requirements, and maintain accurate records, while providing proactive patient outreach and timely case resolution.