The Questions Every Mental Health Practice Asks Before Hiring a Virtual Assistant
By Ashleigh Atuahene, Co-Founder, Ataraxis
Before I helped start Ataraxis, I was the person doing this work. I spent years as a healthcare admin handling intake, scheduling, insurance verification, prior auths, and chart management, including time in behavioral health and ABA under a licensed therapist. So when a therapist or psychiatrist tells me they are drowning in admin and not sure a virtual assistant is the answer, I get it on a personal level.
Over the past year, George and I have sat on calls with dozens of mental health providers. Solo practices, group practices, telehealth startups, ABA clinics, psychiatry practices just getting off the ground. And we’ve found something interesting, everyone asks the same questions. Different states, different EHRs, different specialties, but the same handful of worries come up again and again.
So I pulled those questions straight from our actual conversations and answered them here, as honestly as I can. This isn’t a sales pitch. Where the honest answer is “that is not what we do,” I say so. My hope is that by the end, you will know whether hiring a virtual assistant is the right move for your therapy practice, and what to look for in a company whether or not you choose us.
Table of Contents
TL;DR: The short version
How much does a virtual assistant for mental health practices cost? Full time starts at $1,950 a month (about $11 an hour, based on an average of 174 working hours). Part time starts at $1,100 a month for 20 hours a week. That price is all-inclusive. No setup fees, no search fees, no cancellation fees.
Do you train the assistant on my EHR and my workflows? No. We recruit people who already have several years of US healthcare experience, many of them in mental health, so the systems are not foreign to them. You train them on how your practice does things specifically.
Can I do part time, or is it full time only? Both. Part time has a 20-hour-a-week minimum. You can start part time and move to full time as you grow.
Where are the assistants located? The Philippines, Latin America, South Africa, East Africa, Eastern Europe, and the Caribbean. You can tell us your preference.
Will my patients be able to understand them? Yes. Our bar is simple: if we have to ask a candidate to repeat themselves more than once, they do not move forward in our process. For patient-facing roles we lean toward regions with neutral accents.
How do you handle HIPAA and patient data? We sign a BAA with you, every assistant signs a confidentiality agreement, they access your systems through a VPN, they never download patient information locally, and we run accountability software. We also carry cyber insurance.
Who signs the BAA, you or the assistant? We do. The assistant is employed by us, so the BAA is between Ataraxis and your practice.
Can they do my billing? They can handle insurance verification, prior auths, copay collection, and submitting claims inside your EHR. They are not specialized medical billers, so coding, denials, and appeals are better left to a virtual medical biller.
What if it does not work out? Give us one week’s notice and we replace the person. You are month to month with no lock-in, and you only pay for hours actually worked.
How fast can you fill the role? Often within 48 hours if we already have the right person, usually one to two weeks otherwise.
What makes you different? We source globally instead of from one country, our candidates tend to be more experienced, you work directly with the founders, and I have actually done this job myself.
How it all works
What exactly does a healthcare virtual assistant do?
Pretty much any administrative task that can be done remotely. The most common tasks we place people for are scheduling and rescheduling, answering calls and messages, patient intake, pairing new clients with the right clinician, insurance verification, prior authorizations, collecting copays, coordinating refills with pharmacies, managing your calendar, uploading records and labs, and being the friendly buffer between you and a full inbox so you can actually see patients.
What they do not do is anything that requires your license, and anything hyper-specialized like medical coding or credentialing. More on billing below, because that one deserves its own answer.
How does the process work from start to finish?
It is simpler than most people expect. After we talk and understand what you need, we send you a short services agreement, usually one or two pages. Once that is signed, we go to our talent pool and send you two to four pre-vetted candidates we think fit, along with a quick summary of why and a snippet from their references. You interview them yourself and pick who you want. We agree on a start date, and on that date you get your first invoice through Stripe, which covers the next 30 days. After that it is one invoice a month. We stay in touch after the first day, the first week, and then monthly.
How long does it take to get someone started?
If we already have the right person in our pool, it can be under 48 hours. Most roles fill within one to two weeks. For more complex roles with a lot of moving parts, it can take a little longer, and that is on purpose. We would rather get it right than do it fast.
Can I start part time and move to full time later?
Yes, and a lot of providers do exactly that. Part time has a 20-hour-a-week minimum. One thing to keep in mind is part-time assistants often have another job, so if you want to convert someone to full time later, it depends on their availability at that moment. The cleanest version is when someone joins part time specifically because they want to grow into a full-time role with you. We can help you time it.
The cost
How much does it cost, and what is included?
Full time starts at $1,950 a month. That works out to about $11 an hour across an average of 174 working hours in a month. Part time, at 20 hours a week, starts at $1,100 a month.
That number covers everything including the assistant’s pay, our fee, payment and transfer costs, compliance, time tracking, and the accountability software. There is no setup fee, no search fee, no processing fee, and no cancellation fee. You do not pay anything until you actually hire someone.
Does the price change based on experience?
For most roles, candidates fall right into that rate. It can go up a little if someone has more years of experience, has managed a team, lives in a higher cost-of-living area, or is bilingual (usually one to three dollars an hour more). We tell you the rate for each candidate before you interview them, so you never waste time on someone outside your budget and there are no surprises.
Do your rates go up every year?
We do not have an automatic annual increase. Raises are between you and your assistant, based on their performance and how you feel about their work, just like any employee. Honestly, retention has far more to do with how you treat someone than with small rate bumps. A little PTO, paying them when they are sick once in a while even though you are not required to, and a good working relationship go a lot further than you would think.
Are there any discounts for the first month?
We do not do first-month discounts, and the reason is simple: whatever you pay us flows directly to what the assistant earns. They are counting on their full pay, same as anyone. What we do instead is let you interview several people, run a short paid trial with a couple of assignments if you want, and stay month to month so you are never locked into something that is not working.
The people
How do you vet candidates?
This is the part I am most proud of, because it is built on my own experience of what actually makes someone good at this job. Our team screens roughly 200 to 250 candidates every single week, and our acceptance rate is around 5%.
Here is the funnel. First, an intro screen for communication skills (written and verbal), work-from-home readiness, and whether they present professionally. Then a take-home assignment that tells us a lot about attention to detail, follow-through, responsiveness, and how they handle tricky patient situations while protecting PHI. That stage alone eliminates most people. If they pass, they do a culture-fit interview, and then we check two professional references so we can hear from the providers they actually supported. Only after all of that does someone become eligible to be placed with you.
How much experience do your assistants have?
On average, three to ten years of US healthcare experience, and many specifically in mental and behavioral health. A good number have degrees in psychology or nursing, so this is not just a paycheck for them, it is a field they care about. We also screen hard for people who stay in roles for the long term, because one of the biggest time-wasters for a practice is having to rehire every six months. Past behavior tends to repeat, so we avoid job hoppers on purpose.
Will my patients be able to understand them? I am worried about accents.
This comes up on almost every discovery call, and it is a fair worry. Our standard is that if we have to ask a candidate to repeat themselves more than once during our process, they are automatically disqualified. For roles where someone is talking to patients all day, we tend to lean toward the Philippines, Latin America, and East Africa, where accents are often neutral. We can also give you candidates from a few regions to compare. It really does come down to your personal preference and what sounds good to you. You will get to interview and hear them yourself before you decide.
Where are your assistants located, and can I choose?
We source from the Philippines, Latin America (great for Spanish-speaking roles), South Africa, East Africa, Eastern Europe, and the Caribbean. We do not currently source from India or Pakistan. You are welcome to tell us a preference and we will work within it. If you do not have one, we will usually recommend a region based on the role, especially if it is patient-facing.
Do you have bilingual assistants?
Yes. We regularly place Spanish-English bilingual assistants, mostly from Latin America, and we have placed other languages too. Bilingual roles usually run one to two dollars an hour higher.
Can they really work US time zones?
Yes, and for most of our candidates it is nothing new. A lot of them have worked US hours for years. Overseas outsourcing is such a big part of some of these economies that working the night shift is normal, a bit like how a lot of nurses in the US prefer night shifts. If you need early mornings, specific split shifts, or after-hours coverage, we confirm that a candidate is genuinely comfortable with it before we send them to you.
Security and compliance
How do you handle HIPAA and protect patient data?
Protecting PHI is the thing I am most paranoid about, coming from the admin side myself. Here is the full picture. We sign a BAA with your practice. Every assistant signs a strict confidentiality agreement with us. They access your systems through a VPN so browsing is secure. They do not download any patient information onto their own devices, and doing so is grounds for immediate termination. We run accountability software in the background, and we carry cyber insurance, which is the closest thing to breach coverage, in the rare event something ever goes wrong. It never has, but we would rather have it and not need it.
One piece of advice, whether you work with us or anyone else: ask the company directly how they handle HIPAA and whether they carry that kind of insurance. If they cannot answer clearly, that tells you something.
Who signs the BAA, me and the company or me and the assistant?
You sign it with us. The assistant is technically employed by Ataraxis, so the business associate agreement is between your practice and Ataraxis. This matters, because some companies make you sign the BAA directly with the assistant, or will not sign one at all. We think the practice deserves a real BAA with the company it is paying.
Are your assistants HIPAA certified, and can you give me their training certificate?
Many of our candidates hold a HIPAA certification, though not all do. Where a candidate has one, we are happy to provide it for your files, and we can prioritize certified candidates if that matters to you. We do not run HIPAA training in-house. We recruit people who already have real US healthcare experience and existing knowledge of how to handle PHI, rather than training someone up from scratch.
How do you track their time and make sure they are actually working?
We use accountability software. Assistants clock in and clock out, so you know they are working the hours you are paying for. There is also an optional feature that takes randomized screenshots, which are blurred so no PHI is ever visible. It is really there as a deterrent, and you can toggle it on or off depending on your preference. We are not sitting there watching screens all day, but if there is ever a question, we have a log we can check.
Can you stop someone from copying or downloading patient information?
The honest answer is that no system is a perfect guarantee, and any company that tells you otherwise is overselling. The real safeguards are layered: we vet people thoroughly, they use a VPN, downloading PHI is strictly prohibited and means immediate termination, the monitoring software is a deterrent, and the ultimate failsafe is on your side, which is your ability to revoke their access to your systems instantly. Between all of those layers, problems are very rare.
Billing, tasks, and the limits of the role
Can the assistant handle my billing?
Yes and no, and this is worth getting right. A healthcare virtual assistant can comfortably handle the front-end billing work including insurance verification, prior authorizations, collecting copays and coinsurance, and submitting clean claims inside your EHR. That covers what a lot of smaller practices need.
What they are not is a specialized medical biller. Coding, working denials and rejections, and filing appeals are a different skill set, and that work is usually its own full-time specialty. If your practice has real billing complexity, the right setup is a general admin assistant plus a dedicated biller (which we can also help with), or your assistant plus the billing company you already use. Trying to find one person who is an expert at both the admin side and specialized billing is setting yourself up for disappointment.
Can one assistant follow up on denied or rejected claims?
They can often figure out why a claim was denied and flag it for you, and over a few months a sharp assistant will learn your common denial reasons. But denial management as an ongoing function is specialized billing work. If denials are a meaningful part of your revenue cycle, that belongs with a biller, not a general admin.
How many providers or how much volume can one assistant support?
It depends on the mix of work, but be realistic. If you have, say, 15 therapists generating scheduling, intake, insurance, and billing admin all day, that is almost certainly too much for one person. Plenty of busy solo and small group practices run beautifully on one full-time assistant. Larger practices usually need more than one, or a person plus a biller. On our call we will help you think through what your actual volume calls for rather than just selling you a single seat.
Do your assistants know my EHR?
Probably, and if not, they can pick it up fast. SimplePractice is by far the most common system among the practices we work with, followed by ones like Valant, eClinicalWorks, Athena, Tebra, and Osmind. My advice is to prioritize someone who has used several systems and is a quick study over someone who has only ever touched your exact EHR. A strong assistant can learn a new EHR in a week or two. That said, if a specific EHR is a hard requirement, we can filter for it, just know it narrows the pool.
Can they help with marketing, social media, or content?
For basic tasks like simple social posts or keeping your calendar and profiles updated, yes. But if you want someone to actually create marketing content and run campaigns, that is a different skill set and usually a different person. The empathy and healthcare experience you want in a patient-facing assistant rarely live in the same person as a marketing expert. We can help you find either, just not both in one seat.
Setting it up to actually work
What makes the difference between a VA that works and one that does not?
After all the practices I have watched go through this, it comes down to two things. One is having the right person in the role, which is our job. The other is having good documentation and SOPs, which is yours. The assistant can be excellent, but if there is nothing written down for them to follow, both of you end up frustrated and answering the same questions over and over.
You do not need it to be perfect. Even a simple document of how you want each task handled, sent to your new assistant a couple of days before they start, makes a huge difference. Walk through it together on day one, record that walkthrough so they have something to refer back to, and set up a short weekly check-in. The practices that struggle are almost always the ones flying by the seat of their pants with no documentation at all.
Do you onboard the assistant for me?
We handle everything on the hiring and back-end side including sourcing, vetting, compliance, paying them, and time tracking. The onboarding into your practice is yours, because every practice runs differently and you are the one who knows how you want things done. We will absolutely coach you on how to onboard well, and the right assistant will help you build out your documentation over the first couple of months, but the actual training on your workflows comes from your side.
How do I keep a good assistant long term?
Treat them like a real member of your team, because they are one. Give them some PTO even though you are not contractually required to. Have a short weekly one-on-one meeting. Tell them what is working and what is not. Let them contribute ideas, because a lot of these folks genuinely want to. In my experience, people stay for the relationship and the respect far more than for small pay differences. We also check in with everyone we place at least once a month, and if we hear something you should know, like someone is feeling stretched or deserves a raise, we will tell you.
What makes Ataraxis different
How are you different from the other companies I am talking to?
A few honest differences. Most companies in this space source from a single country. We source globally, which means for a patient-facing role we can find you a neutral accent, and for a Spanish-speaking role we can go to Latin America. Our candidates tend to be more experienced, because we recruit people who have already done this for years rather than training beginners. You work directly with George and me, the founders, not a rotating account manager. We sign a real BAA with you. And the assistant we place is dedicated to you, embedded in your practice, not shared across a dozen clients or handed off to an anonymous call center.
The piece I will add personally is that I have actually sat in the admin chair in multiple healthcare and mental health practices. I built our vetting process around what I know separates a great assistant from a frustrating one. When you tell me what is driving you crazy, I am not guessing or struggling to relate. I have lived it. I know how frustrating following up with insurance companies about denials can be or how much time it takes to perform a proper in-depth intake on the phone. I have used that experience combined with George’s years of recruitment experience to filter through the noise and find candidates that have years of experience, are HIPAA compliant, diligent, and serious professionals who want to work with a US company long-term.
Are the assistants dedicated to me, or shared?
Dedicated. A full-time assistant works only for you and is not allowed to take other jobs. Part-time assistants may have one other role, which is why we have the 20-hour minimum, but even then their time with you is a clear block, not a scattered handful of minutes. This is very different from an answering service or a shared-pool model, and most providers tell us the dedicated relationship is exactly why they chose us.
Where to start
If you are at the point I hear so often on these calls, somewhere between “I cannot keep doing all of this myself” and “I am nervous about handing it off,” that is completely normal, and it is the right time to talk. You do not have to have your SOPs perfect or your systems figured out. We can walk through all of it together, and there is no obligation until you actually hire someone you are excited about.
If you would like to see what the right assistant could do for your practice, reach out and we will set up a short call. I would love to hear what is on your plate and tell you honestly whether we can help.
Ashleigh Atuahene is co-founder of Ataraxis. Before building the company, she provided one-on-one ABA therapy under a licensed therapist and spent years in healthcare administration, handling patient intake, scheduling, prior authorization, insurance, and documentation across pediatric, internal medicine, and behavioral health practices.
