Medical Virtual Assistant – Outbound Calls, Prior Authorization, Claims Support

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

📋 Description

• Process, validate, and manage prescription refill requests.

• Communicate the outcomes of refills to both patients and pharmacies.

• Monitor and oversee refill queues within Athena.

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

• Identify medications that require prior authorization.

• Utilize CoverMyMeds for medication-related requests.

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

• Follow up on pending authorizations and monitor their approval status.

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

• Process appeals and document updates within Athena.

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

• Assist with claims processing and follow up on insurance matters.

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

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

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

• Route claim-related issues to the appropriate billing or clinical staff when escalation is necessary.

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

• Relay provider instructions and clinic updates to patients.

• Employ HIPAA-compliant voicemail practices.

• Respond to patient inquiries about symptoms, devices, test results, or next steps.

• Document patient acknowledgments, pending concerns, and follow-up requirements.

• Schedule or reschedule patient appointments.

• Upload and organize documents received from external facilities.

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

• Notify providers of urgent symptoms or patient requests.

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

• Maintain accurate documentation for inbox and outbox communications.

• Efficiently close completed tasks.

• Report any system access issues or workflow delays.

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

⛳️ Requirements

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

• Proven hands-on experience with Athena is essential.

• Strong experience in navigating Athena task queues, documentation, charting, patient records, and clinical workflows.

• Excellent outbound calling skills and professional communication capabilities.

• Experience with prior authorization processes.

• Background in claims processing or insurance follow-up is required.

• High level of accuracy in documentation and strong task management skills.

• Ability to work independently in a fast-paced clinical environment.

• Familiarity with CoverMyMeds is necessary.

• Comfortable in communication with patients, pharmacies, providers, and insurance representatives.

• Experience in charting or clinical documentation is required.

• CoverMyMeds experience is strongly preferred.

• Experience with Google Voice is preferred.

• Experience using payer portals or insurance verification tools is an advantage.

• Familiarity with Family Medicine or Primary Care is a plus.

• Experience with chronic care or weight-management medication authorizations is a benefit.

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

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

• Ability to maintain HIPAA-compliant communication is essential.

🏝️ Benefits

• Competitive salary and benefits package.

• Opportunities for professional development and growth.

• Supportive work environment focused on teamwork and collaboration.