Virtual Assistant -

We are seeking an experienced Prior Authorization Specialist to support a U.S.-based pain management practice.

This is a part-time role focused specifically on obtaining and following up on prior authorizations for pain-management medications. The workload will begin at approximately 5–10 hours per week and may grow as authorization volume increases.

The ideal candidate has direct, verifiable experience completing medication prior authorizations for a U.S. pain-management, specialty, primary-care, behavioral-health, or similar healthcare practice. You must understand how to submit medication authorizations, work through payer portal requirements, obtain supporting clinical documentation, follow up on pending requests, and address denials or requests for additional information.

Responsibilities
Review medication prior-authorization requests for completeness and accuracy.

Submit medication prior authorizations through CoverMyMeds, payer portals, fax, phone, or other payer-required methods.

Review patient information, prescribing provider details, diagnosis codes, medication name, strength, dosage, quantity, days’ supply, refill information, and supporting clinical documentation.

Confirm payer-specific requirements such as formulary status, step therapy, quantity limits, prior treatment history, medical-necessity criteria, and supporting chart notes.

Track submitted authorizations and follow up promptly on pending requests.

Document approvals, denials, authorization numbers, approved medication details, effective dates, expiration dates, quantity limits, and payer reference numbers.

Communicate approval status, denials, requests for additional documentation, and urgent issues to the practice team.

Coordinate collection of supporting clinical records when needed.

Assist with medication prior-authorization denials, resubmissions, reconsiderations, appeals, and peer-to-peer review coordination when assigned.

Prioritize urgent medication requests and authorizations that may interrupt a patient’s treatment.

Maintain accurate, timely, HIPAA-compliant documentation in the EHR/EMR and authorization tracker.

Required Qualifications
Minimum 2 years of direct U.S. healthcare prior-authorization experience.

Confirmed experience handling medication prior authorizations for pain-management patients.

Experience with controlled and non-controlled pain-management medications, formulary restrictions, step therapy, quantity limits, and medical-necessity documentation.

Proficiency with CoverMyMeds and insurance payer portals.

Familiarity with CPT codes, ICD-10 codes, medical terminology, medication dosing, quantity calculations, days’ supply, and prescription-related documentation.

Experience working in a U.S. EHR/EMR and documenting authorization activity accurately.

Strong written and spoken English for communication with insurance representatives, pharmacies, providers, and clinical staff.

Excellent organization, urgency, attention to detail, and follow-through.

Understanding of HIPAA and secure handling of protected health information.

Reliable computer, stable high-speed internet, and a professional workspace.

Preferred Qualifications
Experience in a pain-management clinic or interventional pain practice.

Familiarity with prior authorizations for non-opioid pain medications, topical therapies, neuropathic pain medications, muscle relaxants, migraine medications, and specialty medications.

Experience responding to payer denials, formulary alternatives, step-therapy requirements, quantity-limit exceptions, reconsiderations, and appeals.

Experience with Athenahealth, eClinicalWorks, Epic, NextGen, AdvancedMD, Tebra/Kareo, or similar EHR/EMR platforms.

How To Apply
Please submit:

Your resume in PDF format.

A short summary of your direct U.S. healthcare medication prior-authorization experience.

A description of your experience with pain-management medication authorizations.

A list of the payer portals, EHR/EMR systems, and prior-authorization tools you have used.

Your desired hourly rate in USD.

Your availability in Philippine Time.