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.