Bilingual Back-Office Insurance & Prior Authorization

GoLean Health; Caracas; Remote; VES 7,420,000 - 9,893,000; Full time

Job summary

GoLean Health is seeking a bilingual Virtual Medical Assistant for back-office insurance verification, prior authorizations, and patient enrollment support for a United States nonprofit behavioral health organization. The role focuses on administrative workflows, eligibility verification, and coordination to move patients through enrollment and care initiation.

You will work remotely with a US-based team, handling insurance requirements, documentation, and follow-up across commercial plans,

Qualifications

• Experience in healthcare administration with insurance verification and prior authorizations.
• Experience 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 with good follow-up and organization.

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 and follow-up as needed.

Skills

Bilingual English/Spanish

Healthcare administration

Independent work

Attention to detail

Follow-up skills

Tools

AdvancedMD

Microsoft Teams

Time Doctor

Payer portals

Job description

Remote | Behavioral Health | 30 hours/week | $7/Hour

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

Role Overview

We are seeking an experienced Bilingual 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.

Patient Care Coordination, 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.

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.

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.

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.
• 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.
• 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