Back-Office Insurance & Prior Authorization

GoLean Health; Cavite City; Remote; PHP 431,000 - 518,000; Part time

Job summary

GoLean Health is seeking an experienced Back-Office Insurance & Prior Authorization Virtual Medical Assistant to support a nonprofit behavioral health organization in the United States. This role focuses on administrative and insurance work to move patients through enrollment and prepare them for care.

The candidate will verify insurance, process prior authorizations, review eligibility, handle enrollment, and support credentialing, with emphasis on HIPAA compliance and careful documentation.

Qualifications

• Experience with insurance verification and prior authorizations.
• Experience with US commercial insurance plans and Medicaid.
• Experience contacting insurance companies and using payer portals.
• Strong understanding of eligibility and authorization workflows.
• Experience using an EHR or practice-management system.
• Strong data-entry and documentation skills.
• Excellent attention to detail and accuracy.
• Able to manage multiple cases independently.
• Knowledge of HIPAA and patient confidentiality.
• Reliable attendance and punctuality.

Responsibilities

• Insurance Verification & Benefits: Verify patient eligibility and benefits with commercial plans and Medicaid.
• Review payer information and document verification results in AdvancedMD and related systems.
• Identify insurance requirements or missing information.”
• Prior Authorizations: Initiate and process authorization requests per payer and clinic requirements.
• Communicate with insurance representatives and use payer portals to obtain requirements and status.
• Track pending authorization requests through approval or denial.
• Financial Eligibility & Patient Follow-Up: Review documentation to determine nonprofit financial assistance eligibility.
• Follow up with patients for missing forms, signatures, or enrollment requirements.
• Maintain documentation of eligibility status and coordinate with the front-desk VMA.
• Patient Intake & Enrollment: Set up patient profiles and collect required forms.
• Review intake docs for missing information and follow up with patients for enrollment requirements.
• Track patients through intake and enrollment and coordinate with the front-desk VMA.
• Provider Credentialing Support: Assist with provider credentialing and payer enrollment.
• Organize credentialing documents, payer correspondence, and renewal information.
• Follow up on pending items and communicate requirements.
• EHR & Chart Preparation: Update demographics, insurance, authorization, and eligibility data in AdvancedMD.
• Prepare patient charts for appointments and verify documents.
• Resolve incomplete information before scheduling.
• Backlog & Case Management: Review outstanding cases and prioritize by urgency.
• Determine blockers and take appropriate follow-up actions.
• Maintain documentation of outreach and next steps until resolution.
• Cross-Functional Administrative Support: Provide additional admin support and cross-training.
• Coordinate with bilingual front-desk VMA for smooth handoffs.
• Cover related workflows when trained.
• SOP & Process Development: Document verification, authorization, and enrollment procedures.
• Update SOPs as payer requirements change.
• Identify bottlenecks and suggest process improvements.

Skills

Healthcare experience

Insurance verification

Prior authorizations

EHR experience

Data entry

Attention to detail

Organization

English communication

HIPAA compliance

Remote work

Multitasking

Tools

AdvancedMD

Payer portals

Time Doctor

Job description

Remote | Behavioral Health | 30 hours/week | $5-$6/hour

Working Hours: 11:00 AM to 7:00 PM US Central Time

Role Overview
We are seeking an experienced Back-Office Insurance & Prior Authorization Virtual Medical Assistant to support a nonprofit behavioral health organization in the United States.
This position will focus primarily on the administrative and insurance-related work required to move patients successfully through enrollment and prepare them for care.
The clinic serves patients using multiple payer arrangements, including commercial insurance, Medicaid, self-pay, and nonprofit programs that may reduce or eliminate the patient\'s cost of care. Because each patient may require a different process, the successful candidate must be highly organized and capable of determining what documentation, eligibility verification, authorization, or follow-up is needed for each case.
You will also help address existing administrative backlogs and build reliable back-office processes that the organization can continue using as it grows.

Key Responsibilities
Insurance Verification & Benefits

• Verify patient eligibility and applicable benefits with commercial insurance plans and Medicaid.
• Review payer information and document verification results accurately in AdvancedMD and related clinic systems.
• Identify insurance requirements, coverage issues, or missing information that could prevent a patient from progressing through enrollment.

Prior Authorizations

• Initiate and process prior authorization requests according to payer and clinic requirements.
• Communicate with insurance representatives and use payer portals to obtain requirements, authorization status, and supporting information.
• Track pending authorization requests and follow them through approval, denial, or other appropriate resolution.

Financial Eligibility & Patient Follow-Up

• Review patient information and required documentation to determine potential eligibility for nonprofit financial assistance or reduced-cost programs.
• Conduct outbound follow-up with patients regarding missing forms, insurance information, signatures, or other incomplete enrollment or eligibility requirements.
• Maintain accurate documentation of eligibility status and pending requirements, and coordinate with the front-desk VMA once the patient is ready to proceed toward scheduling.

Patient Intake & Enrollment

• Support patient intake by setting up patient profiles and portals, collecting required forms, and ensuring demographic and insurance information is complete and accurately documented.
• Review intake documentation for missing or incomplete information and conduct outbound follow-up with patients to obtain required forms, signatures, insurance details, or other enrollment requirements.
• Track each patient through the intake and enrollment process, coordinate with the front-desk VMA, and confirm that all required administrative steps are completed before the patient proceeds to scheduling.

Provider Credentialing Support

• Assist with provider insurance credentialing and payer enrollment as the clinic expands the scope of the position.
• Organize required credentialing documents, payer correspondence, application statuses, and renewal information.
• Follow up on pending credentialing items and communicate outstanding requirements to the appropriate clinic team member.

EHR & Chart Preparation

• Update patient demographics, insurance information, authorization details, financial eligibility information, and related administrative records in AdvancedMD.
• Prepare patient charts before appointments and confirm that required administrative documents are complete and available.
• Identify incomplete or inconsistent information and resolve or escalate issues before the patient\'s scheduled visit.

Backlog & Case Management

• Review outstanding patient and administrative cases and prioritize them based on urgency, status, and required next action.
• Determine what is preventing each case from progressing and take appropriate follow-up action with the patient, payer, or internal team.
• Maintain clear documentation of outreach attempts, completed work, pending items, and next steps until each case reaches resolution.

Cross-Functional Administrative Support

• Provide additional healthcare administrative support during available capacity and as cross-training develops.
• Coordinate closely with the bilingual front-desk VMA to ensure patients transition smoothly between inquiry, enrollment, insurance processing, and scheduling.
• Provide coverage for related workflows when appropriately trained and within the defined scope of the position.

SOP & Process Development

• Help document insurance verification, prior authorization, financial eligibility, and enrollment follow-up procedures.
• Update Standard Operating Procedures as payer requirements and clinic workflows are clarified or improved.
• Identify recurring back-office bottlenecks and recommend processes that improve consistency, accuracy, and turnaround time.

Required Qualifications

• Previous healthcare experience with substantial responsibility for insurance verification and prior authorizations.
• Experience working with US commercial insurance plans, Medicaid, or both.
• Experience contacting insurance companies and using payer portals.
• Strong understanding of healthcare eligibility and authorization workflows.
• Experience using an EHR or practice-management system.
• Strong administrative documentation and data-entry skills.
• High attention to detail and accuracy.
• Strong follow-up, organization, and task-management skills.
• Professional verbal and written English communication.
• Ability to work independently and manage multiple pending cases.
• Strong understanding of HIPAA and patient confidentiality requirements.
• Reliable attendance and punctuality.

Preferred Qualifications

• Behavioral health or mental health administrative experience.
• Experience with AdvancedMD.
• Experience evaluating patient financial eligibility.
• Experience supporting Medicaid populations.
• Provider credentialing or payer enrollment experience.
• English and Spanish bilingual proficiency.

Systems & Tools
The clinic uses or expects the VMA to work with:

• AdvancedMD
• Microsoft Teams
• Phone services
• Insurance payer portals
• Patient intake portals and online forms
• VPN and secure remote-access systems
• Time Doctor

Remote Work Requirements
Candidates must maintain:

• Private and secure home workspace
• Reliable computer capable of supporting healthcare applications and multiple browser-based systems
• Stable primary internet connection, reliable backup internet
• Verified backup power source
• Professional headset
• Secondary monitor
• Quiet working environment appropriate for patient and insurance calls

What Success Looks Like
Success in this position requires strong ownership and follow-through.
The ideal candidate does not simply complete individual insurance tasks. You should be able to look at a pending patient case, determine what is preventing it from moving forward, identify the next action, complete the necessary follow-up, and continue managing the case until the appropriate resolution has been reached.
You will help ensure patients do not remain unnecessarily stuck in the enrollment process because of missing documentation, incomplete insurance requirements, pending authorizations, or administrative backlogs.