Prior Authorization Virtual Assistant
Prior authorization is where care stalls and revenue leaks. A dedicated authorization assistant initiates requests, assembles the clinical documentation payers want, and follows every case to a decision so procedures happen on time and claims are not denied for a missing auth.
What the Authorization Assistant Handles
Auth Requirement Lookup
Confirms whether a scheduled service needs authorization and under which payer policy before it is booked or performed.
Clinical Packet Prep
Pulls the notes, codes, and medical-necessity documentation the payer requires so the request is approvable on first submission.
Submission and Tracking
Submits through payer portals or fax, logs the reference, and follows up on a schedule until a decision is recorded.
Retro Authorization
Pursues retroactive authorization on services already rendered to recover claims that would otherwise be written off.
Peer-to-Peer Coordination
Schedules and preps peer-to-peer reviews when a request is pended or denied so the provider's time is used efficiently.
Status Visibility
Maintains a live view of every pending request so nothing sits unworked until the procedure date arrives.
Stop Losing Claims to Missing Auths
Tell us which procedures stall on authorization. We'll scope a dedicated assistant.
Prior Authorization Savings Calculator
Most practices underestimate what prior authorization work actually costs in-house, because the wage is only part of it. Enter your numbers to see the fully loaded cost and what the virtual model typically saves against it.
Across everyone who touches this task. 40 hrs is roughly one full-time person.
Base wage only. Benefits, payroll tax, and overhead are added automatically below.
Your fully loaded in-house cost
$56,004
per year for prior authorization work
Typical annual savings with the virtual model
$28,002 to $39,203
a virtual model commonly runs $16,801 to $28,002/yr
Estimate only. Employer burden and overhead use standard ranges; the savings band reflects what outsourced virtual staffing is widely reported to deliver versus a fully loaded in-house hire. Your quoted rate is a flat monthly figure based on scope. Call 888-701-6090.
The Cost of an Authorization Gap
A missing or late authorization has two costs. The first is clinical: the procedure is delayed and the patient waits, which is the part everyone sees. The second is financial: the claim is denied for no authorization, and recovering it means a retro request and an appeal, if it is recoverable at all. Authorization denials are among the most expensive to chase because the service has already been delivered and the money is at risk, not just pending.
A dedicated assistant removes the gap by owning the workflow from requirement check through approval, so the auth exists before the service and the claim is clean when it goes out. Prevention here is dramatically cheaper than recovery.
The Authorization Workflow
Requirement check. Before a service is scheduled or performed, the assistant confirms whether it needs authorization under the patient's specific plan, because the same CPT code can require auth on one plan and not another.
Packet assembly. The assistant pulls the notes, diagnosis, codes, and medical-necessity documentation the payer policy actually requires and assembles it the way that policy reads, so the request is approvable on first submission rather than pended for more information.
Submission and logging. The request goes through the payer portal or fax, the reference number is logged, and the expected decision window is recorded.
Follow-up to decision. Pending requests are worked on a schedule until a decision is in hand. When a payer pends or denies, the assistant coordinates a peer-to-peer review and preps the provider so that call is short and effective.
Retro recovery. For services already rendered without an auth, the assistant pursues retroactive authorization to recover claims that would otherwise be a write-off.
Approvable on First Submission
Most authorization denials are not flat no decisions. They are incomplete submissions sent back for more information, which restarts the clock and pushes the procedure date. The fix is preparing the request the way the payer's policy reads the first time: the right codes, the matching diagnosis, and the medical-necessity documentation attached, not promised.
The assistant builds the packet to that standard before submitting, then tracks the reference number on a follow-up schedule so a pending request does not sit untouched until someone notices the procedure is tomorrow. The difference between a first-pass approval and a resubmission is usually documentation discipline, not payer mood.
VA Model Versus Managed Authorization
Our managed prior and retro authorization service runs the whole function for you and reports results. The assistant model puts a dedicated person inside your systems and workflow, working your authorization queue and reporting to your office. Choose the model that fits how you want the work delivered. The clinical and follow-up rigor is the same either way, and the documentation standards that drive first-pass approval do not change.
Where Authorization Hands Off
The authorization assistant owns the auth lifecycle. Detecting that a service needs auth in the first place often starts with an insurance verification assistant, and the underlying coding and medical-necessity rules are the same ones documented on our specialty billing cheat sheets. Clear scope is what makes the approval rate a number you can hold the role to.
Frequently Asked Questions
Get Authorizations Done Before the Procedure
Call 888-701-6090 to add a dedicated prior authorization assistant.