Remote Insurance & Authorization Specialist for Behavioral Health

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

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.