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 refills to patients and pharmacies.

• Monitor and oversee refill queues within Athena.

• Reconcile any duplicate, closed, or pending refill items.

• Identify medications that need prior authorization.

• Utilize CoverMyMeds for requests related to medications.

• Submit and monitor prior authorizations, and follow up on approvals.

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

• Handle appeals and document updates within Athena.

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

• Review claim statuses through payer portals or insurance channels.

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

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

• Conduct outbound calls for reminders, updates, and follow-ups.

• Relay instructions from providers and updates from clinics.

• Address patient inquiries and document concerns along with follow-up needs.

• Schedule or reschedule appointments as necessary.

• Upload and systematically organize external clinical documents.

• Notify providers about urgent symptoms or patient requests.

• Request and track lab results efficiently.

• Maintain thorough documentation in both inbox and outbox.

• Close completed tasks and direct work to clinical, billing, or provider teams.

• Report any system access issues or workflow delays.

⛳️ Requirements

• Minimum of 1 year of experience as a Medical Virtual Assistant, Clinical Support VA, Medical Assistant, or in a similar position.

• Proficient in Athena, including managing task queues, documentation, charting, patient records, and clinical workflows.

• Exceptional outbound calling abilities and professional communication skills.

• Experience with prior authorizations is required.

• Background in claims processing or following up with insurance is necessary.

• Strong skills in documentation accuracy and task management.

• Capability to work independently in a dynamic clinic environment.

• Familiarity with CoverMyMeds is essential.

• Comfortable interacting with patients, pharmacies, providers, and insurance representatives.

• Experience in charting or clinical documentation is preferred.

• Prior experience with CoverMyMeds is strongly desired.

• Experience with Google Voice is preferred.

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

• Experience in Family Medicine or Primary Care is advantageous.

• Background in chronic care or weight-management medication authorizations is beneficial.

• Experience in following up on denied or pending claims is a plus.

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

• Ability to maintain communication that complies with HIPAA regulations.

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and growth.

• Supportive and collaborative work environment.

• Flexible working hours.