A Medical Virtual Assistant – Prior Authorization Specialist manages the end-to-end prior authorization process for our healthcare practitioners. You will serve as the primary liaison between healthcare providers, insurance companies, and patients to ensure timely approvals for procedures, medications, diagnostic testing, and specialist referrals. Your work will directly impact patient care access, practice workflow, and revenue cycle efficiency.
TASKS:
Submitting, tracking, and following up on prior authorization requests.
Managing inbound and outbound calls with healthcare insurance companies to verify authorization requirements, check status updates, and resolve pending or denied requests.
Verifying patient healthcare insurance coverage, benefits, and specific plan requirements prior to scheduling procedures or submitting authorizations.
Retrieving relevant medical history, clinical notes, and diagnostic reports.
Acting as the primary point of contact between medical providers, patients, and payors.
Identifying reasons for authorization denials, gathering missing clinical information, and preparing basic appeal packages under the direction of healthcare providers.
Providing specialized back-office support, including data entry, email management, authorization tracking log maintenance, and record management.
Strictly adhering to HIPAA regulations and maintaining confidentiality across all patient data, insurance details, and communications.
Requirements
QUALIFICATIONS:
Minimum of 6 months to 1 year of prior authorization or healthcare BPO experience handling US healthcare accounts.
Strong familiarity with insurance portals, EMR/EHR systems, and medical terminology.
HIPAA Certification is a plus
Excellent time management
Strong attention to detail
Computer savvy
Great work attitude and willingness to go the extra mile
Open to working night shifts
MINIMUM SYSTEM REQUIREMENTS:
PRIMARY SYSTEM
Computer Processor: Intel Core i5-6000 (6th Gen or higher) or AMD Ryzen 5 2000 series or higher
Computer Memory/RAM: 8.00 GB
Computer Operating System: At least Windows 11 64-bit or macOS Sonoma (14)
Headset: Any USB-type headset with noise-cancelling feature
Camera: Capable of a clear and crisp video output
BACK-UP SYSTEM
OPTION 1 (BACKUP SYSTEM):
Computer Processor: Intel Core i5-6000 (6th Gen or higher) or AMD Ryzen 5 or higher
Computer Memory/RAM: 8.00 GB
Computer Operating System: At least Windows 11 64-bit or macOS Sonoma (14)
Headset: Any USB-type headset with noise-cancelling feature (Optional)
OPTION 2 (POWER SUPPLY - UPS):
Must be capable of powering your work station for at least 3 hours
Typically a device with 240Wh or higher will be sufficient
Must be capable of accepting all the plugs required to maintain the primary device and work environment (device, monitor, modem, cell phone if using as internet backup)
PRIMARY INTERNET CONNECTION
DSL / Fiber Connection - Minimum of 100mb/s contracted
BACK-UP INTERNET CONNECTION
Minimum of 20mb/s (Cell)
RECOMMENDED SYSTEM REQUIREMENTS
PRIMARY SYSTEM
Computer Processor: Intel Core i7 and i9 Core or Core Ultra or AMD Ryzen 7 3000 series or higher
Computer Memory/RAM: 16.00 GB
Computer Operating System: At least Windows 11 64-bit or macOS Tahoe
Headset: Any USB-type headset with noise-cancelling feature
Camera: Capable of a clear and crisp video output
BACK-UP SYSTEM
OPTION 1 (BACKUP SYSTEM):
Computer Processor: Intel Core i7 and i9 Core or Core Ultra or AMD Ryzen 7 or higher
Computer Memory/RAM: 16.00 GB
Computer Operating System: At least Windows 11 64-bit or macOS Tahoe
Headset: Any USB-type headset with noise-cancelling feature
Camera: Capable of a clear and crisp video output
OPTION 2 (POWER SUPPLY - UPS):
Must be capable of powering your work station for at least 3 hours
Typically a device with 240Wh or higher will be sufficient
Must be capable of accepting all the plugs required to maintain the primary device and work environment (device, monitor, modem, cell phone if using as…