Remote Prior Authorization Specialist (Athena, CoverMyMeds)

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

Descripción de la vacante

GoLean Health seeks a Medical Virtual Assistant to support a U.S. medical practice remotely. The role emphasizes medication prior authorization, insurance coordination, and patient communication, with hands‑on experience using Athenahealth and CoverMyMeds to drive timely submissions.

The ideal candidate is highly organized, detail‑oriented, and capable of handling back‑office tasks alongside live patient calls from a remote setting, ensuring HIPAA compliance and accurate record keeping.

Formación

• Hands-on experience using Athenahealth 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.

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.

Conocimientos

Athenahealth

CoverMyMeds

Prior authorization

Insurance coordination

Patient communication

HIPAA compliance

Herramientas

Availity

Athenahealth

Descripción del empleo

GoLean Health seeks a Medical Virtual Assistant to support a U.S. medical practice remotely. The role emphasizes medication prior authorization, insurance coordination, and patient communication, with hands‑on experience using Athenahealth and CoverMyMeds to drive timely submissions.

The ideal candidate is highly organized, detail‑oriented, and capable of handling back‑office tasks alongside live patient calls from a remote setting, ensuring HIPAA compliance and accurate record keeping.