Remote Prior Authorization & Insurance Specialist

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

Descripción de la vacante

Go Lean Health seeks an experienced Medical Virtual Assistant to support a busy U.S. primary care practice. You will specialize in prior authorizations, insurance coordination, and patient communication, using Athenahealth and CoverMyMeds.

This remote role requires strong organization, reliability, and the ability to manage time‑sensitive tasks with minimal supervision. HIPAA compliance and precise documentation are essential.

Formación

• Hands-on experience using Athenahealth for patient records and submissions.

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.

Conocimientos

Athenahealth

CoverMyMeds

Prior authorization

US healthcare experience

US insurance concepts

ICD-10 interpretation

Phone support

English communication

Organization

Independent work

Backup power and internet

GLP-1 prior authorizations

Availity

Medicare/Medicare Advantage

Appeal coordination

Primary care support

Herramientas

Availity

Athenahealth

CoverMyMeds

Descripción del empleo

Go Lean Health seeks an experienced Medical Virtual Assistant to support a busy U.S. primary care practice. You will specialize in prior authorizations, insurance coordination, and patient communication, using Athenahealth and CoverMyMeds.

This remote role requires strong organization, reliability, and the ability to manage time‑sensitive tasks with minimal supervision. HIPAA compliance and precise documentation are essential.