Medical Virtual Assistant Outbound Calls Prior Authorization And Claims Support

Remote | Family Medicine Clinic | 30 Hours/Week | $6/Hour

About The Role

A busy Family Medicine Clinic is looking for a highly skilled Medical Virtual Assistant with strong experience in Athena, outbound calling, prior authorization, clinical documentation, claims support, and patient communication.

This role is ideal for someone who is detail-oriented, organized, proactive, and comfortable working in a fast-paced primary care setting. The right candidate must be able to communicate clearly with patients, pharmacies, providers, and insurance representatives while maintaining accurate documentation and HIPAA-compliant communication.

Key Responsibilities

Medication & Refill Management

• Process, validate, and route prescription refill requests
• Communicate refill outcomes to patients and pharmacies
• Track and manage refill queues in Athena
• Reconcile duplicate, closed, or pending refill items between pharmacy and provider
• Identify medications that require prior authorization
• Maintain and actively use CoverMyMeds for medication-related requests
  
  
  

Prior Authorization & Appeals

• Submit and track prior authorizations for chronic care and weight-management medications
• Follow up on pending authorizations and proactively check approval status
• Coordinate approvals, denials, and additional information requests with providers
• Process appeals when needed and document all updates accurately in Athena
• Identify delays or issues with systems such as CoverMyMeds and Evicore
  
  
  

Claims Processing & Insurance Follow-Up

• Assist with basic claims processing and insurance-related follow-ups
• Review claim status through payer portals or insurance communication channels
• Follow up on denied, rejected, or pending claims as instructed
• Document claim updates, payer responses, and next steps accurately
• Route claim concerns to the appropriate billing or clinical staff when escalation is needed
• Support the team in keeping claim-related tasks organized and updated
  
  
  

Patient Communication

• Conduct outbound calls for appointment reminders, updates, and follow-up needs
• Relay provider instructions and clinic updates professionally
• Use HIPAA-appropriate voicemail practices when leaving messages
• Respond to patient inquiries regarding symptoms, devices, test results, or next steps
• Document patient acknowledgments, pending concerns, and follow-up requirements
• Schedule or reschedule appointments as needed
  
  
  

Clinical Coordination

• Upload and organize documents from external facilities
• Manage discharge summaries, imaging results, clinical notes, and lab-related documents
• Notify providers of urgent symptoms or patient requests through the appropriate channel
• Request lab results from external labs and track pending items
• Ensure clinical information is routed to the correct team member promptly
  
  
  

Administrative Support

• Maintain accurate inbox and outbox documentation
• Close completed tasks efficiently and correctly
• Report system access issues or workflow delays when necessary
• Route tasks to the appropriate clinical, billing, or provider team
• Keep documentation clean, updated, and easy to follow
  
  
  

Required Tools & Platforms

• Athena expertise is a must
• Strong experience navigating Athena task queues, documentation, charting, patient records, and clinical workflows
• CoverMyMeds experience is strongly preferred
• Google Voice experience is preferred
• Charting or clinical documentation experience is required
• Experience using payer portals or insurance verification tools is a plus
  
  
  

Qualifications

Required

• At least 1 year of experience as a Medical Virtual Assistant, Clinical Support VA, Medical Assistant, or similar role
• Proven hands-on experience with Athena is required
• Strong outbound calling skills and professional communication
• Prior authorization experience
• Claims processing or insurance follow-up experience
• Strong documentation accuracy and task management skills
• Ability to work independently in a fast-paced clinic environment
• Familiarity with CoverMyMeds
• Comfortable communicating with patients, pharmacies, providers, and insurance representatives
  
  
  

Nice to Have

• Family Medicine or Primary Care experience
• Experience handling prior authorizations for chronic care medications
• Experience with weight-management medication authorizations
• Experience following up on denied or pending claims
• Experience requesting records, lab results, imaging results, or discharge summaries
  
  
  

Ideal Candidate Profile

The ideal candidate is someone who has strong Athena expertise and can confidently manage clinical and administrative workflows inside the system. They should be organized, proactive, and able to take ownership of tasks from start to finish.

This person should be comfortable making outbound calls, tracking prior authorizations, supporting claims-related follow-ups, and documenting every update accurately. The role requires someone who is reliable, detail-oriented, and able to support both clinical and administrative workflows with professionalism.

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