Virtual Healthcare Assistant

About the role

EDGE is seeking a Virtual Healthcare Assistant to support US‑based healthcare providers. The role involves acting as a liaison between patients, providers, and insurers, handling eligibility checks, prior authorizations, and scheduling.

Key responsibilities

• Conduct eligibility and benefits verification for patients before appointments.
• Interpret insurance policies (PPO, HMO, Medicare/Medicaid) and determine patient financial responsibilities.
• Prepare and submit prior authorization requests via portals, fax, or phone.
• Review clinical documentation to ensure medical necessity criteria are met.
• Track pending authorizations, manage appeals, and expedite urgent requests.
• Handle inbound/outbound calls for scheduling, rescheduling, and reminders.

Required profile

• At least 1 year of direct experience in US healthcare scheduling, eligibility, prior authorizations, or insurance verification.
• Deep understanding of US insurance concepts such as PPO, HMO, EOBs, copays, and patient benefits.
• Exceptional attention to detail, strong analytical skills, and excellent written and verbal English communication.
• Ability to work independently in a fast‑paced environment.

Required skills

• Proficiency with insurance portals (e.g., Availity, Optum, CoverMyMeds).
• Experience using electronic health record/practice management systems (e.g., ECW, Tebra, Dentrix).