Medical VA – Prior Authorization, Patient Coordinator – Pediatrics

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

📋 Description

• Proactively initiate, monitor, and oversee medication prior authorization cases from the pre-submission phase to the final decision.

• Analyze insurance denials, collect clinical documentation and chart notes from the EHR, and formulate and submit appeal letters.

• Prepare for peer-to-peer reviews effectively.

• Engage with U.S. commercial, Medicare, and Medicaid payers to track case status, clarify clinical criteria, and resolve authorization delays.

• Act as the main point of contact for U.S. patients and their parents through phone, SMS, and email communication.

• Provide updates regarding medication status, insurance information, and appointment scheduling.

• Clearly and empathetically explain insurance procedures, coverage delays, and out-of-pocket cost estimates.

• Verify medical and pharmacy benefits, copays, deductibles, and formulary coverage accurately.

• Maintain thorough documentation, logs, and status updates across practice management systems, payer portals, and communication platforms.

• Identify workflow obstacles and escalate complex clinical issues to providers as needed.

• Adapt to specific practice protocols and operate independently after completing onboarding and training.

⛳️ Requirements

• A minimum of 2+ years of direct experience managing medication prior authorizations, including handling denials, formulary exceptions, and appeals.

• Excellent spoken English, strong active listening abilities, and a confident, friendly phone demeanor.

• Demonstrated experience in U.S. healthcare workflows.

• Proficient in medical and pharmacy insurance verifications.

• Background in front-desk operations or patient care coordination.

• Familiar with CoverMyMeds and major U.S. insurance portals.

• Knowledge of HIPAA-compliant communication tools.

• Experience with standard EHR platforms such as AthenaHealth, eClinicalWorks, or equivalents.

• Highly accountable and exceptionally organized.

• Strong independent problem-solving capabilities and disciplined follow-through.

• Experience in pediatric practice, family practice, or direct interaction with parents/guardians is highly preferred.

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and career advancement.

• Supportive work environment with a focus on teamwork.

• Flexible work arrangements and work-life balance initiatives.