Healthcare Assistant

EDGE is connecting top global talent with the US Healthcare and Insurance industry by building a borderless network focused on people. We are seeking a Virtual Healthcare Assistant to support US-based healthcare providers. The ideal candidate will have experience in scheduling, eligibility verification, prior authorizations, and insurance verification within the US healthcare system. This role serves as a vital link between patients, healthcare providers, and insurance companies, requiring a detail-oriented and tech-savvy professional who can efficiently navigate insurance portals and electronic health records to ensure timely patient care.

Key Responsibilities
- Conduct thorough eligibility checks and benefits verification for patients before their appointments.
- Interpret complex insurance policies, including PPO, HMO, and Medicare/Medicaid guidelines.
- Determine patient financial responsibilities such as deductibles, copays, and coinsurance, and document these accurately in the practice management system.
- Prepare and submit prior authorization requests through various channels including web portals, fax, and phone.
- Review clinical documentation like progress notes, lab results, and physician orders to confirm medical necessity prior to submission.
- Monitor the status of pending authorizations, manage appeals for denied claims, and expedite urgent requests to avoid delays in patient care.
- Manage inbound and outbound patient calls to schedule, reschedule, and remind patients of wellness visits and routine check-ups.

Required Qualifications
- Minimum of 1 year of direct experience in the US healthcare industry, particularly in scheduling, eligibility, prior authorizations, and insurance verification.
- Strong understanding of US insurance concepts including PPO, HMO, Explanation of Benefits (EOBs), copays, and patient benefits eligibility.
- Proficiency in using insurance portals such as Availity, Optum, Covermymeds, and electronic health record/practice management systems like ECW, Tebra, or Dentrix.
- Exceptional attention to detail, strong analytical skills, and excellent written and verbal communication in English.
- Ability to work independently and efficiently in a fast-paced environment.

Preferred Qualifications and Benefits
While specific preferred qualifications and benefits are not explicitly listed, candidates who demonstrate a proactive approach to managing insurance processes and patient communications will thrive in this role. Joining EDGE means becoming part of a global talent network that values diversity, inclusion, and the opportunity to work remotely with US healthcare clients. EDGE is committed to creating a fair and borderless employment environment where professionals can unlock their potential and earn competitive wages.

The hiring process includes a thorough application review, an interview with an EDGE representative, onboarding and training, followed by client interviews to ensure the best match. Successful candidates will join the EDGE Global Talent Community and contribute meaningfully to the healthcare industry.

EDGE is an equal opportunity employer dedicated to fostering a diverse and inclusive workplace. All qualified applicants will be considered without regard to race, color, religion, gender identity or expression, sexual orientation, national origin, disability, age, veteran status, or any other protected status.