Prior Authorizations & Referrals Specialist

Job Title: Prior Authorizations & Referrals Specialist

Job Code: [BW-PCDGP]

Position type: Full-time

Work hours: 8:00 AM -5:00 PM Central Time, Monday - Friday

Salary: $5-$6 per hour depending on experience

Key Responsibilities:

• Process and follow up on prior authorizations for medications and referrals
• Clear and manage existing authorization backlog
• Communicate with insurance companies to expedite approvals
• Handle denials, resubmissions, and documentation requirements
• Process referrals, especially for Medicare Advantage plans
• Verify eligibility and authorization requirements
• Coordinate with specialists and insurance providers
• Verify insurance coverage and benefits
• Schedule appointments and send reminders
• Handle inbound calls and reduce missed calls/hold times
• Respond to patient inquiries professionally and promptly

Requirements:
• At least 1 year of proven experience in a healthcare setting as a Medical Virtual Assistant or in a similar medical administrative role.
• Knowledge of Medicare Advantage plans
• Hands-on experience with Athena EHR (required)
• Experience in insurance verification and medical billing processes
• Strong understanding of payer guidelines and documentation requirements
• Ability to manage high-volume workloads efficiently

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 10 Mbps).
• Audio: Noise-canceling headset.
• Video: Webcam for virtual meetings.
• Workspace: Quiet, professional environment.

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.

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.