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

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

📋 Description

• Process, validate, and direct prescription refill requests.

• Communicate outcomes of refills to patients and pharmacies.

• Monitor and manage refill queues within Athena.

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

• Identify medications that necessitate 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 verify their approval status.

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

• Process appeals and document updates in Athena.

• Identify delays or issues within CoverMyMeds and Evicore.

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

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

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

• Document claim updates, responses from payers, and subsequent steps.

• Route claim concerns to billing or clinical staff when escalation is necessary.

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

• Relay provider instructions and clinic updates.

• Adhere to HIPAA-compliant voicemail practices.

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

• Schedule or reschedule appointments as needed.

• Upload and organize documents from external facilities.

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

• Notify providers of urgent symptoms or requests from patients.

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

• Maintain documentation in both inbox and outbox.

• Efficiently close completed tasks.

• Report any system access issues or workflow delays.

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

⛳️ Requirements

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

• Proficiency in Athena is essential.

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

• Excellent outbound calling skills and professional communication abilities.

• Experience with prior authorizations.

• Knowledge of claims processing or insurance follow-up is required.

• Strong skills in documentation accuracy and task management.

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

• Familiarity with CoverMyMeds is important.

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

• Experience in charting or clinical documentation is necessary.

• Experience with CoverMyMeds is highly preferred.

• Familiarity with Google Voice is preferred.

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

• Experience in Family Medicine or Primary Care is advantageous.

• Experience with authorizations related to chronic-care and weight-management medications is beneficial.

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

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

• Maintain HIPAA-compliant communication at all times.

🏝️ Benefits

• Comprehensive health and wellness programs.

• Opportunities for professional development and career advancement.

• Flexible work schedule and remote work options available.

• Supportive team environment and culture.