Medical VA - Prior Authorization… at Staffing for… · Philippin…

Position Overview

We are seeking a detail-oriented, highly proactive Healthcare Virtual Assistant (HVA) specializing in Medication Prior Authorizations (PAs) and high-touch patient care coordination. In this role, you will independently manage end-to-end medication PAs—from initial submission through appeals and approvals—while serving as a compassionate, clear communicator for our U.S. patients and families.

The ideal candidate combines strong clinical administrative expertise (handling payer portals, denials, and appeals) with exceptional spoken English and a warm phone presence. Experience in pediatrics is a significant plus.

Key Responsibilities

1. Medication Prior Authorization & Appeals Management

• End-to-End PA Ownership: Independently initiate, track, and manage active medication prior authorization cases from pre-submission to final decision.
• Denial & Appeal Handling: Review insurance denials, gather required clinical documentation/chart notes from EHR, and draft/submit formal appeal letters and peer-to-peer review prep.
• Payer Communication: Proactively contact U.S. commercial, Medicare, and Medicaid payers to track status, clarify clinical criteria, and resolve authorization bottlenecks.

2. Patient Coordination & Front-Desk Communication

• Direct Patient Engagement: Serve as a primary point of contact for U.S. patients or parents via phone, SMS, and email regarding medication status, insurance updates, and appointment scheduling.
• Empathetic De-escalation: Explain complex insurance processes, coverage delays, and out-of-pocket estimates to patients with clarity, warmth, and high listening comprehension.
• Insurance Verification: Verify medical and pharmacy benefits, copays, deductibles, and formulary coverage prior to order queuing.

3. Workflow Execution & Administrative Accountability

• EHR & Portal Hygiene: Maintain pristine documentation, logs, and status updates across practice management systems, payer portals (CoverMyMeds, Availity, NaviNet), and communication channels.
• Escalation Judgment: Apply strong problem-solving skills to identify workflow roadblocks early and escalate complex clinical issues to providers only when necessary.
• Independent Execution: Quickly adapt to practice-specific protocols and operate autonomously following initial onboarding and training.

Qualifications & Key Attributes

• Prior Authorization Expertise: Minimum 2+ years of hands-on experience specifically managing medication prior authorizations, including handling denials, formulary exceptions, and appeals.
• Exceptional English Fluency: Superior spoken English, active listening skills, and a confident, warm phone presence suitable for communicating directly with U.S. patients, parents, and pharmacy reps.
• Healthcare & Insurance Background: Proven experience in U.S. healthcare workflows, medical/pharmacy insurance verifications, and front-desk or patient care coordination.
• Pediatric Experience (Preferred): Prior experience working in a pediatric practice, family practice, or dealing directly with parents/guardians is highly advantageous.
• Systems & Portal Competency: Familiarity with CoverMyMeds, major US insurance portals, HIPAA-compliant communication tools, and standard EHR platforms (e.g., AthenaHealth, eClinicalWorks, or similar).
• Core Competencies: High accountability, meticulous organization, independent problem-solving skills, and disciplined follow-through on open cases.