Healthcare Prior Authorization & Insurance… at Winning… · Colômbia

Job Title: Healthcare Prior Authorization & Insurance Verification Virtual Assistant

Position Type: Full-Time

Work Hours: 8:00 AM – 5:00 PM CDT

Work Days: Monday – Thursday

Salary: $5 – $6 per hour (depending on experience)

Job Code: KF-VCPB

Workplace: Remote

Preferred Candidate Location: Philippines or Latin America

About the Role

We are seeking an experienced Healthcare Virtual Assistant to support a busy vascular surgery practice with prior authorizations, insurance verification, referrals, patient estimates, and medical records coordination.

This role requires someone who can work independently, think critically, and manage multiple time-sensitive requests while maintaining accuracy and professionalism. The ideal candidate has extensive experience working with U.S. healthcare practices and is highly skilled in authorization workflows, insurance verification, CPT coding review, and clinical documentation support.

Core Responsibilities

Prior Authorization Management (Top Priority)

• Manage prior authorizations for vascular surgery procedures
• Submit and track radiology authorizations (CT, MRI, MRA, CTA, Ultrasound)
• Monitor authorization requests and update CPT codes when procedures change
• Prepare and submit authorization letters and supporting documentation
• Communicate with insurance companies regarding approvals, denials, modifications, and status updates
• Manage TriWest and Veteran authorization requests
• Review patient charts and gather supporting clinical documentation for insurance submissions
• Collaborate with providers and nurses to obtain missing clinical information

Insurance Verification, Referrals & Patient Estimates (Top Priority)

• Verify insurance eligibility and patient benefits
• Handle HMO referrals and referral follow-ups
• Review patient notes and identify appropriate CPT codes
• Generate patient cost estimates based on CPT codes and insurance coverage
• Verify copays, deductibles, and out-of-pocket expenses
• Assist with patient billing inquiries and insurance-related questions

Medical Records & Clinical Documentation Coordination (Top Priority)

• Process and follow up on medical record requests
• Ensure imaging reports, laboratory results, and medical records are received before appointments
• Review clinical notes and extract relevant information for authorizations
• Maintain accurate documentation within the EHR/EMR system
• Monitor internal communications and respond to authorization-related requests in real time

Additional Administrative Support

• Follow up on billing claims and insurance issues
• Manage documentation related to referrals, insurance, billing, and patient records
• Provide administrative support for healthcare operations and scheduling workflows

Software & Systems

• CGM EMD (CompuGroup Medical EMD)
• Microsoft Teams
• SIP Trunk VoIP System
• Sangoma Digium App

Key Performance Indicators (KPIs)

• Timely submission and approval of prior authorizations

• Accurate insurance verification and patient cost estimates

• Efficient management of referrals and authorization requests

• Complete and accurate documentation within the EHR

• Timely follow-up on insurance and medical record requests

• Responsiveness to urgent authorization and scheduling needs

• Consistent communication with providers, nurses, insurance companies, and patients

• Extensive experience with prior authorizations is required

• Extensive experience with insurance verification and benefits verification is required

• Experience managing HMO referrals and authorization workflows is required

• Strong understanding of CPT codes and medical billing processes is required

• Experience working with U.S. healthcare practices is required

• Healthcare administrative experience is required

• Experience with vascular surgery, specialty care, or radiology authorizations is highly preferred

• Previous virtual assistant experience preferred but not required

Required Skills

• Strong understanding of prior authorization processes
• Experience handling radiology authorizations (CT, MRI, MRA, CTA, Ultrasound)
• Ability to review clinical notes and gather supporting documentation
• Experience with patient estimates and insurance benefit verification
• Strong documentation and record management skills
• Proficiency with EHR/EMR systems
• Strong critical thinking and problem-solving abilities
• Excellent organizational and time management skills
• Ability to manage multiple authorization requests simultaneously
• Strong communication skills with insurance companies, providers, nurses, and patients
• Ability to work independently with minimal supervision
• Strong sense of urgency and follow-through

Preferred Qualities

• Highly detail-oriented and accurate
• Proactive and resourceful
• Professional and dependable
• Comfortable in a fast-paced healthcare environment
• Quick learner who can adapt to new systems and workflows
• Takes ownership of tasks and follows through to resolution

Deal Breakers

• No prior authorization experience
• No insurance verification experience
• No experience with HMO referrals
• Weak understanding of CPT codes and medical billing processes
• No experience working with U.S. healthcare practices
• Poor attention to detail
• Inability to manage multiple requests simultaneously
• Lack of responsiveness during work hours
• Failure to comply with HIPAA, security, antivirus, or VPN requirements

Basic requirements

• Must be proficient in speaking and writing English very clearly
• Must have relevant work experience
• Be able to submit an NBI clearance and/or Local Police Clearance background check before onboarding [mandatory]
• Must be available for video meetings with your camera on (when needed)

Technical requirements

• Device: Reliable laptop or desktop computer.

• Internet: High-speed connection (minimum 25 Mbps).

• Audio: Noise-canceling headset.

• Video: Webcam for virtual meetings.

• Workspace: Quiet, professional environment.

• Dedicated HR & Contractor Support Team: Access to world-class support for questions, guidance, contract matters, and client communication.

• Premium VPN Access (Optional): A secure VPN license can be provided upon request to enhance privacy and security for client-related tasks.

• HIPAA & Cybersecurity Training + Certification (Provided): Access to our internal HIPAA compliance training, cybersecurity modules, and certification to help you confidently handle PHI for U.S. healthcare clients.

• Top 1% VA Performance Training: Access to our proprietary training on communication, client management, productivity systems, and best practices to help you become a top-performing VA and increase long-term client retention.

• Client-Approved U.S. Holidays: Contractors may take U.S. holidays off according to the client’s needs and schedule.

• Client-Approved Paid or Unpaid Time Off: Time off may be granted by your client. Paid time off is optional and only if offered by the client.

• Access to Tools & Resources: Templates, workflow guides, productivity tools, and client-specific SOP support to help you perform at your best.

• Optional Performance-Based Incentives: Some clients may offer bonuses, incentives, or increased hours based on your performance.

These are optional resources and client-approved allowances available to you as an independent contractor. Any resources, trainings, or allowances listed are optional contractor perks and not employee benefits.