Healthcare Prior Authorization, Insurance Verification Virtual Assistant

Role Overview

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

Requirements

• 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.

Tech Stack

• VoIP

Benefits

• 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.