Bilingual Back-Office Insurance & Prior Authorization

GoLean Health; Maracaibo; A distancia; VES 7.142.000 - 10.171.000; A tiempo parcial

Descripción de la vacante

GoLean Health is seeking an experienced bilingual back-office medical assistant to support a US nonprofit behavioral health organization. This remote role focuses on insurance verification, prior authorizations, intake, and enrollment to move patients through enrollment and prepare them for care.

You will work with AdvancedMD and payer portals, coordinate with front-desk staff, and ensure documentation is complete and accurate.

Formación

• : Experience with US commercial insurance plans or Medicaid.
• : Experience contacting insurance companies and using payer portals.
• : Experience using an EHR or practice-management system.
• : High attention to detail and accuracy.
• : Strong follow-up, organization, and task-management skills.
• : Ability to work independently and manage multiple pending cases.
• : Knowledge of HIPAA and patient confidentiality requirements.
• : Reliable attendance and punctuality.

Responsabilidades

• Verify patient eligibility and benefits with commercial insurance plans and Medicaid.
• Review payer information and document results in AdvancedMD and clinic systems.
• Identify insurance requirements or missing information to progress enrollment.

Conocimientos

Healthcare experience

Insurance verification

Prior authorizations

Payer portals

EHR / practice-management

Data entry

Attention to detail

Independent work

HIPAA compliance

Follow-up

Herramientas

AdvancedMD

Microsoft Teams

Time Doctor

VPN / remote-access

Phone systems

Payer portals

Patient intake portals

Descripción del empleo

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