Remote Insurance & Prior Authorization Specialist

Go Lean Health; Philippines; On-site; PHP 431,000 - 517,000; Part time

Benefits offered by this job

Remote work

Job summary

Go Lean Health in the Philippines seeks a Back-Office Insurance & Prior Authorization Virtual Medical Assistant to support a nonprofit behavioral health organization in the United States.

This remote role focuses on insurance verification, prior authorizations, eligibility review, and chart preparation to move patients through enrollment. Strong organization and communication are essential.

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.

Responsibilities

• 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.
• 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.
• 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.
• 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 upscale issues before the patient\u2019s scheduled visit.
• 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.
• 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.
• 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.
• 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.

Skills

Insurance verification

Prior authorizations

EHR systems

Attention to detail

Organizational skills

English communication

Payer portals

Tools

AdvancedMD

Microsoft Teams

Payer portals

Time Doctor

Job description

Go Lean Health in the Philippines seeks a Back-Office Insurance & Prior Authorization Virtual Medical Assistant to support a nonprofit behavioral health organization in the United States.

This remote role focuses on insurance verification, prior authorizations, eligibility review, and chart preparation to move patients through enrollment. Strong organization and communication are essential.