Remote Prior Authorization & Patient Care Coordinator

GoLean Health; Iloilo City; Remote; PHP 440,000 - 528,000; Full time

Job summary

GoLean Health seeks an experienced Medical Virtual Assistant to support a U.S. primary care practice remotely. You will specialize in medication prior authorizations, insurance coordination, and patient communication, managing submissions, records, and follow-ups with a hands-on approach.

The role requires independent work, strong English communication, and meticulous documentation within Athenahealth, across payer portals, and with external providers. Remote flexibility is offered.

Qualifications

• Hands-on experience with Athenahealth is mandatory.
• Hands-on experience with CoverMyMeds for medication prior authorization is mandatory.
• Experience preparing, submitting, tracking, and following up on medication prior authorization requests independently.
• Experience supporting a U.S. healthcare practice in medical administration, insurance coordination, or clinical support.
• Working knowledge of U.S. health insurance processes, Medicare, and HMO authorization requirements.
• Ability to interpret clinical notes, ICD-10 codes, medication histories, and insurance documentation requirements.
• 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 and attention to detail; ability to manage multiple time-sensitive requests.
• Demonstrated ability to work independently and follow through on unresolved cases.

Responsibilities

• Initiate, submit, track, and follow up on medication prior authorizations using CoverMyMeds.
• Process authorizations for GLP-1 and weight-management, ADHD, 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 manage outstanding cases.
• 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 and follow-up needs.
• Coordinate referrals and medical records requests with external facilities.
• Maintain accurate patient records and authorization updates in Athenahealth.
• Track submissions, approvals, denials, and expiration dates; ensure follow-up actions.
• Take ownership of assigned cases and resolve within 72 hours when possible.
• Ensure HIPAA compliance and adherence to practice procedures.

Skills

English communication

Independent worker

Organizational skills

HIPAA knowledge

Tools

Athenahealth (Athena)

CoverMyMeds

Job description

GoLean Health seeks an experienced Medical Virtual Assistant to support a U.S. primary care practice remotely. You will specialize in medication prior authorizations, insurance coordination, and patient communication, managing submissions, records, and follow-ups with a hands-on approach.

The role requires independent work, strong English communication, and meticulous documentation within Athenahealth, across payer portals, and with external providers. Remote flexibility is offered.