Prior Authorization, Insurance & Patient Support

Prior Authorization, Insurance & Patient Support

Remote | Primary Care / Family Medicine | 40 Hours/Week | $5-$6/Hour
Required Systems: Athenahealth (Athena), CoverMyMeds

About the Role

We are seeking an experienced Medical Virtual Assistant with strong expertise in medication prior authorization, insurance coordination, and patient communication to support a busy U.S. medical practice.

This role requires someone who can independently manage prior authorization requests, navigate insurance requirements, review clinical documentation, communicate with patients and insurance representatives, and maintain accurate records in Athenahealth.

The ideal candidate is proactive, highly organized, detail-oriented, and comfortable balancing back-office responsibilities with live patient calls. This is a hands-on position requiring practical experience in U.S. healthcare operations, strong follow-through, and the ability to manage time-sensitive requests with minimal supervision.

Key Responsibilities

1. Medication Prior Authorization & Insurance Coordination

• Initiate, submit, track, and follow up on medication prior authorizations using CoverMyMeds.

• Process authorizations for GLP-1 and weight-management medications, ADHD medications, hormonal treatments, and other prescriptions requiring insurance approval.

• Review clinical documentation, diagnoses, ICD-10 codes, medication histories, and payer requirements to ensure accurate submissions.

• Handle Medicare GLP-1 Bridge requests and specialist visit authorizations for HMO and Medicare Advantage plans.

• Navigate insurance portals, including Availity, to verify requirements and obtain authorization approvals.

• Monitor pending requests, coordinate missing documentation, and escalate denials or clinical questions to the appropriate provider.

• Initiate new authorization requests ideally within 24 hours of patient visits and proactively manage outstanding cases.

2. Patient Communication & Care Coordination

• Manage inbound patient calls, voicemails, and outbound communications with patients, pharmacies, insurance companies, and healthcare providers.

• Conduct outbound calls for appointment scheduling, including Annual Wellness Exams, and other follow-up needs.

• Coordinate specialist referrals, insurance approvals, and medical records requests with external healthcare facilities.

• Independently manage the patient phone queue during designated coverage periods.

• Provide clear, professional communication while escalating clinical concerns to the appropriate healthcare professional.

3. EHR Documentation, Case Management & Administrative Support

• Maintain accurate and timely patient records, authorization updates, and follow-up documentation using Athenahealth (Athena).

• Track authorization submissions, approvals, denials, expiration dates, and pending actions.

• Request and process medical records from primary care providers, specialists, laboratories, imaging centers, and other authorized parties.

• Take ownership of assigned cases, working toward resolution within 72 hours whenever possible.

• Coordinate with clinical staff to resolve outstanding requests, prioritize urgent tasks, and maintain continuity of patient care.

• Ensure all activities comply with HIPAA requirements and established practice procedures.

Required Qualifications

• Hands-on experience using Athenahealth (Athena) is mandatory.

• Hands-on experience using CoverMyMeds for medication prior authorization is mandatory.

• Proven experience independently preparing, submitting, tracking, and following up on medication prior authorization requests.

• Previous experience supporting a U.S. healthcare practice in medical administration, insurance coordination, or clinical support.

• Working knowledge of U.S. health insurance processes, pharmacy benefits, Medicare, Medicare Advantage, and HMO authorization requirements.

• Ability to interpret clinical notes, diagnoses, ICD-10 codes, medication histories, and insurance documentation requirements accurately.

• Experience handling inbound and outbound calls with U.S. patients, insurance representatives, pharmacies, and medical offices.

• Strong spoken and written English communication skills, with clear pronunciation and professional phone etiquette.

• Excellent organizational skills, attention to detail, and the ability to manage multiple time-sensitive requests.

• Demonstrated ability to work independently, maintain accurate documentation, and follow through on unresolved cases.

• Back up power and internet are needed.

Preferred Qualifications

• Experience processing GLP-1 and medical weight-management medication prior authorizations.

• Familiarity with Medicare GLP-1 Bridge authorization requirements.

• Experience using Availity for insurance verification and specialist visit authorizations.

• Experience handling complex medication authorizations, insurance denials, and appeal coordination.

• Previous experience supporting a primary care or family medicine practice.

Important: This position requires demonstrated, hands-on prior authorization experience. General medical administrative experience or basic familiarity with insurance terminology alone is not sufficient. Applicants must be confident using Athenahealth and CoverMyMeds, interpreting documented clinical information, coordinating with insurance companies, and communicating directly with patients.