Healthcare Prior Authorization, Insurance Verification Virtual Assistant

This is a fully remote position, open to applicants in Philippines.

📋 Description

• Oversee prior authorizations for vascular surgery procedures.

• Submit and monitor radiology authorizations (CT, MRI, MRA, CTA, Ultrasound).

• Track authorization requests and update CPT codes as procedures evolve.

• Prepare and dispatch authorization letters along with supporting documentation.

• Liaise with insurance companies regarding approvals, denials, modifications, and status updates.

• Manage TriWest and Veteran authorization requests.

• Review patient records and collect necessary clinical documentation for insurance submissions.

• Collaborate with healthcare providers and nursing staff to gather any missing clinical information.

• Confirm insurance eligibility and assess patient benefits.

• Handle HMO referrals and follow up on referrals.

• Review patient notes to identify the correct CPT codes.

• Generate patient cost estimates based on CPT codes and insurance coverage.

• Verify copays, deductibles, and out-of-pocket expenses.

• Assist with patient billing inquiries and any insurance-related questions.

• Process and track medical record requests.

• Ensure imaging reports, laboratory results, and medical records are obtained prior to appointments.

• Review clinical notes and extract pertinent information for authorizations.

• Maintain precise documentation within the EHR/EMR system.

• Monitor internal communications and respond promptly to authorization-related requests.

• Follow up on billing claims and resolve insurance issues.

• Manage documentation associated with referrals, insurance, billing, and patient records.

• Provide administrative support for healthcare operations and scheduling workflows.

• Familiarity with CGM EMD (CompuGroup Medical EMD).

• Proficient in Microsoft Teams.

• Experience with SIP Trunk VoIP System.

• Knowledge of Sangoma Digium App.

⛳️ Requirements

• Significant experience with prior authorizations is necessary.

• Extensive knowledge of insurance verification and benefits verification is essential.

• Proven experience managing HMO referrals and authorization workflows is required.

• Strong comprehension of CPT codes and medical billing processes is vital.

• Experience within U.S. healthcare practices is a must.

• Prior healthcare administrative experience is required.

• Familiarity with vascular surgery, specialty care, or radiology authorizations is highly preferred.

• Previous experience as a virtual assistant is favored but not mandatory.

• Required Skills:

• Strong knowledge of prior authorization processes.

• Experience dealing with radiology authorizations (CT, MRI, MRA, CTA, Ultrasound).

• Ability to review clinical notes and gather relevant documentation.

• Experience with patient estimates and verification of insurance benefits.

• Strong documentation and record management capabilities.

• Proficiency in EHR/EMR systems.

• Excellent critical thinking and problem-solving skills.

• Outstanding organizational and time management abilities.

• Capability to manage multiple authorization requests concurrently.

• Strong communication skills with insurance companies, providers, nurses, and patients.

• Ability to work independently with minimal oversight.

• Strong sense of urgency and follow-through.

• Preferred Qualities:

• Highly detail-oriented and precise.

• Proactive and resourceful.

• Professional and reliable.

• Comfortable in a dynamic healthcare environment.

• Quick learner who can adapt to new systems and workflows.

• Takes ownership of tasks and ensures completion.

• Deal Breakers:

• Lack of prior authorization experience.

• No experience with insurance verification.

• Absence of experience regarding HMO referrals.

• Weak understanding of CPT codes and medical billing processes.

• No experience in U.S. healthcare practices.

• Poor attention to detail.

• Inability to manage multiple requests at once.

• Lack of responsiveness during working hours.

• Failure to adhere to HIPAA, security, antivirus, or VPN requirements.

• Basic requirements:

• Must be proficient in clear spoken and written English.

• Must possess relevant work experience.

• Required to submit an NBI clearance and/or Local Police Clearance background check before onboarding.

• Must be available for video meetings with the camera on as needed.

• Technical requirements:

• Device: Reliable laptop or desktop computer.

• Internet: High-speed connection (minimum 25 Mbps).

• Audio: Noise-canceling headset.

• Video: Webcam for virtual meetings.

• Workspace: Quiet and professional environment.

🏝️ Benefits

• Dedicated HR & Contractor Support Team: Access to exceptional support for inquiries, guidance, contract matters, and client communication.

• Premium VPN Access (Optional): A secure VPN license can be provided upon request to enhance privacy and security for client-related tasks.

• HIPAA & Cybersecurity Training + Certification (Provided): Access to our internal HIPAA compliance training, cybersecurity modules, and certification to confidently manage PHI for U.S. healthcare clients.

• Top 1% VA Performance Training: Access to our exclusive training on communication, client management, productivity systems, and best practices to help you excel as a top-performing VA and improve long-term client retention.

• Client-Approved U.S. Holidays: Contractors may take U.S. holidays off according to client needs and scheduling.

• Client-Approved Paid or Unpaid Time Off: Time off may be granted by your client, with paid time off being optional and only if offered by the client.

• Access to Tools & Resources: Templates, workflow guides, productivity tools, and client-specific SOP support to assist you in performing at your best.

• Optional Performance-Based Incentives: Some clients may offer bonuses, incentives, or increased hours based on your performance.