Remote Medical VA: Prior Authorization & Insurance Support

GoLean Health; Pampanga; A distancia; PHP 440.000 - 527.000; Jornada completa

Descripción de la vacante

GoLean Health seeks an experienced Medical Virtual Assistant to manage medication prior authorizations, insurance coordination, and patient communication for a U.S. medical practice.

The role balances back-office tasks with live patient calls and requires hands-on experience with Athenahealth and CoverMyMeds. Responsibilities include processing GLP-1/weight-management authorizations, portal navigation (Availity), and thorough EHR documentation.

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.
• Experience handling inbound and outbound calls with U.S. patients, insurance representatives, pharmacies, and medical offices.
• Strong spoken and written English communication skills, with clear pronunciation and professional phone etiquette.
• Excellent organizational skills, attention to detail, and the ability to manage multiple time-sensitive requests.
• Demonstrated ability to work independently, maintain accurate documentation, and follow through on unresolved cases.
• Back up power and internet are needed.

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.
• 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.

Conocimientos

Athenahealth experience

CoverMyMeds experience

US healthcare operations

English communication

Detail-oriented

Time management

Herramientas

Athenahealth

CoverMyMeds

Availity

Descripción del empleo

GoLean Health seeks an experienced Medical Virtual Assistant to manage medication prior authorizations, insurance coordination, and patient communication for a U.S. medical practice.

The role balances back-office tasks with live patient calls and requires hands-on experience with Athenahealth and CoverMyMeds. Responsibilities include processing GLP-1/weight-management authorizations, portal navigation (Availity), and thorough EHR documentation.