Prior Authorization Representative - Virtual Assistant
Prior Authorization Representative - Virtual Assistant
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Job Description
This is a remote position.
Virtual Rockstar is seeking a highly detail-oriented self-motivated Prior Authorization Representative to join our team in supporting a North Carolina-based pediatric therapy practice. This is a fully remote full-time contractor role ideal for someone with experience in authorizations for occupational speech or physical therapy services especially under Medicaid and commercial insurance plans.
About the Practice
Our partner therapy practice is passionate about providing wraparound care that elevates the standards of therapy. Their mission goes beyond clinical outcomes they support the whole family through education compassion and collaboration. Core values include:
Communication: Clear compassionate and adaptive.
Authenticity: Genuine and relationship-driven.
Collaboration: Team-oriented support for families.
Open-mindedness: Growth-focused and self-directed.
Dependability: Consistent follow-through.
Advocacy: Equity for clients of all races identities and abilities.
Youll be a key contributor to a billing team that works closely with clinicians and administrative staff ensuring clients receive uninterrupted access to care.
What You ll Do
As the Prior Authorization Representative you will manage the end-to-end lifecycle of therapy service authorizations with precision consistency and proactive follow-up. Key responsibilities include:
Insurance Verification:
Confirm patient insurance eligibility for Medicaid NC Medicaid Managed Care Tailored Health Plans Tricare and commercial insurers.
Update patient insurance information accurately in the EMR system.
Prior Authorization Management:
Prepare and submit initial and concurrent authorizations.
Monitor timelines and proactively follow up to prevent lapses in coverage.
Track and log detailed authorization data for reporting and auditing.
Coordination & Communication:
Liaise with therapists physicians and billing staff to obtain required documentation.
Make outbound calls to insurance providers and clients.
Submit and manage out-of-network agreement requests medical record submissions and additional documentation for audits or claims as needed.
Documentation & Compliance:
Maintain up-to-date client files in the EMR (Jane).
Ensure HIPAA compliance across all communication and documentation processes.
Tools Youll Use
You ll work with a modern digital stack including:
Jane (EMR)
Google Workspace (Gmail Docs Sheets Meet)
RingCentral (VoIP and faxing)
NCTracks (Medicaid portal)
Insurance portals (payer-specific)
Zoom (team meetings and trainings)
Requirements
You thrive in fast-paced environments and can independently manage complex workflows. Our ideal candidate has:
Proven experience in prior authorization and insurance verification for therapy services.
Familiarity with NC Medicaid Tailored Health Plans and MCOs is a major plus.
Exceptional attention to detail and time management skills.
Clear and professional communication (written and verbal).
Flexibility positivity and a strong sense of ownership.
Proficiency in Microsoft and general computer literacy.
Availability during U.S. Eastern business hours.
Additional Notes
This is a remote independent contractor role.
Must be able to work U.S. Eastern Time (ET) business hours.
Reports directly to the Billing Director and collaborates regularly with clinicians.
Benefits
Competitive salary commensurate with experience.
Opportunities for professional development and growth.
Work in a dynamic and supportive team environment.
Make a meaningful impact by helping to build and strengthen families in the Philippines.
Previous experience in a medical administrative role (medical assistant, medical receptionist, or similar) is preferred. Familiarity with WebPT EMR and Therabill for patient payment posting is a plus. Strong communication skills, both written and verbal. Ability to manage multiple tasks and prioritize effectively. Excellent organizational skills and attention to detail. High level of professionalism and commitment to maintaining patient confidentiality. Comfortable with remote work and proficient in using virtual communication tools. Knowledge of insurance verification and pre-authorizations is a plus. Ability to work collaboratively with a team and contribute to a positive patient experience.
Employment Type
Full Time
