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.

• Inform patients and pharmacies about refill outcomes.

• Monitor and handle refill queues within Athena.

• Reconcile instances of duplicate, closed, or pending refills between the pharmacy and 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 their approval status.

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

• Process appeals and document updates in Athena.

• Identify and address delays or issues with CoverMyMeds and Evicore.

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

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

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

• Document claim updates, payer responses, and next steps.

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

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

• Relay provider instructions and clinic updates effectively.

• Use HIPAA-compliant voicemail practices.

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

• Schedule or reschedule appointments as necessary.

• Upload and organize documents 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 monitor pending items.

• Maintain accurate documentation in the inbox and outbox.

• Efficiently close completed tasks.

• Report any system access issues or workflow delays.

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

• Ensure documentation is clean, updated, and easy to follow.

⛳️ Requirements

• 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 outbound calling skills along with professional communication abilities.

• Experience in prior authorization processes.

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

• Excellent documentation accuracy and task management capabilities.

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

• Familiarity with CoverMyMeds is necessary.

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

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

• Experience in charting or clinical documentation is mandatory.

• Strong preference for candidates with CoverMyMeds experience.

• Google Voice experience is preferred.

• Familiarity with payer portals or insurance verification tools is advantageous.

• Experience in Family Medicine or Primary Care is a plus.

• 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 an added advantage.

🏝️ Benefits

• Competitive salary and compensation package.

• Opportunities for professional development and training.

• Flexible working hours and remote work options.

• Supportive and collaborative team environment.

• Health and wellness benefits.