Medical Virtual Assistant, Outbound Calls, Prior Authorization

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

📋 Description

• Process, validate, and manage prescription refill requests.

• Communicate the outcomes of refill requests to both patients and pharmacies.

• Monitor and oversee refill queues within Athena.

• Reconcile duplicate, closed, or pending refill items between pharmacy and provider.

• Identify medications that require prior authorization.

• Utilize CoverMyMeds for medication-related inquiries.

• Submit and track prior authorizations for chronic care and weight management medications.

• Follow up on pending authorizations and check the status of approvals.

• Coordinate with providers regarding approvals, denials, and additional information requests.

• Process appeals and accurately document updates in Athena.

• Identify any delays or issues related to CoverMyMeds and Evicore.

• Assist with claims processing and follow-ups related to insurance.

• Review claim statuses through payer portals or insurance communication channels.

• Follow up on claims that are denied, rejected, or pending.

• Document updates regarding claims, payer responses, and next steps.

• Route any claim concerns to the appropriate billing or clinical staff when necessary.

• Conduct outbound calls for appointment reminders, updates, and follow-up requirements.

• Communicate provider instructions and clinic updates in a professional manner.

• Adhere to HIPAA-compliant voicemail practices.

• Address patient inquiries concerning symptoms, devices, test results, or next steps.

• Schedule or reschedule appointments as required.

• Upload and organize documentation from external facilities.

• Manage discharge summaries, imaging results, clinical notes, and lab-related documents.

• Notify providers of urgent patient symptoms or requests.

• Request lab results from external labs and track any pending items.

• Maintain precise documentation in both inbox and outbox.

• Close completed tasks efficiently and accurately.

• Report any system access issues or workflow delays.

• Route tasks to the relevant clinical, billing, or provider teams.

• Support the clinical and administrative workflows of a busy family medicine clinic.

⛳️ Requirements

• A minimum of 1 year of experience as a Medical Virtual Assistant, Clinical Support VA, Medical Assistant, or a similar role.

• Hands-on experience with Athena is essential.

• Strong familiarity with navigating Athena task queues, documentation, charting, patient records, and clinical workflows.

• Excellent outbound calling skills and professional communication abilities.

• Experience with prior authorization processes.

• Experience in claims processing or insurance follow-ups.

• Strong skills in documentation accuracy and task management.

• Ability to work independently in a dynamic clinic environment.

• Familiarity with CoverMyMeds is important.

• Capability to communicate effectively with patients, pharmacies, providers, and insurance representatives.

• Experience in charting or clinical documentation is required.

• Prior experience with CoverMyMeds is strongly preferred.

• Experience with Google Voice is preferred.

• Familiarity with payer portals or tools for insurance verification is a plus.

• Experience in Family Medicine or Primary Care is a nice addition.

• Experience in managing authorizations for chronic care and weight-management medications is a plus.

• Experience with follow-ups on denied or pending claims is an advantage.

• Experience in requesting records, lab results, imaging results, or discharge summaries is desirable.

🏝️ Benefits

• Competitive salary.

• Opportunities for professional development.

• Supportive work environment.

• Flexible scheduling options.