Bilingual Back-Office Insurance & Prior Authorization
About this role
Bilingual Back-Office Insurance & Prior Authorization
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
Originally posted on Himalayas