Remote Insurance Verification & Credentialing Specialist

GoLean Health; Cavite City; Remote; PHP 430,000 - 516,000; Full time

Job summary

GoLean Health seeks a Back-Office Insurance & Prior Authorization Virtual Medical Assistant to support a U.S. nonprofit behavioral health organization.

The role focuses on insurance verification, prior authorizations, enrollment, and building reliable back-office processes for ongoing operations. You will verify eligibility with commercial plans and Medicaid, document results in AdvancedMD, manage authorizations, and coordinate with the bilingual front-desk VMA to move patients toward scheduling

Qualifications

• Experience handling insurance verification and prior authorizations.
• Experience with US commercial insurance plans and Medicaid.
• Experience contacting insurance companies and using payer portals.
• Understanding of healthcare eligibility and authorization workflows.
• Experience using an EHR or practice-management system.
• Strong administrative documentation and data-entry skills.
• Attention to detail and accuracy.
• Strong follow-up and organizational skills.
• Professional English communication.
• Ability to manage multiple cases independently.
• HIPAA and patient confidentiality knowledge.
• Reliable attendance and punctuality.

Responsibilities

• Verify patient eligibility and benefits with commercial insurance and Medicaid.
• Review payer information and document results in AdvancedMD and clinic systems.
• Identify missing information that could block enrollment.
• Initiate and process prior authorizations according to payer requirements.
• Communicate with insurance representatives and use payer portals.
• Track and follow pending authorizations through resolution.
• Review patient data to determine nonprofit eligibility or reduced-cost programs.
• Conduct outbound follow-ups for missing forms or enrollment steps.
• Maintain documentation of eligibility status and pending requirements.
• Coordinate with front-desk VMA to move patient toward scheduling.
• Set up patient profiles, collect forms, and ensure complete insurance data.
• Prepare patient charts before appointments and verify completeness.
• Review backlog cases and prioritize actions.
• Coordinate cross-functional administrative support with bilingual front desk VMA.
• Document SOPs and update processes as payer requirements change.

Skills

Insurance verification

Prior authorizations

Office administration

Communication (English)

Tools

AdvancedMD

Payer portals

EHR system

Job description

GoLean Health seeks a Back-Office Insurance & Prior Authorization Virtual Medical Assistant to support a U.S. nonprofit behavioral health organization.

The role focuses on insurance verification, prior authorizations, enrollment, and building reliable back-office processes for ongoing operations. You will verify eligibility with commercial plans and Medicaid, document results in AdvancedMD, manage authorizations, and coordinate with the bilingual front-desk VMA to move patients toward scheduling