Provider Credentialing & Back-Office Insurance Specialist
About this role
Back-Office Insurance & Prior Authorization
Remote | Behavioral Health | 30 hours/week | $5-$6/hour
Working Hours: 11:00 AM to 7:00 PM US Central Time
Role Overview
We are seeking an experienced 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.
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.
Patient 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.
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.
EHR & Chart Preparation
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 escalate issues before the patient's scheduled visit.
Backlog & Case Management
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.
Cross-Functional Administrative Support
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.
SOP & Process Development
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.
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.
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.
Preferred Qualifications
Behavioral health or mental health administrative experience.
Experience with AdvancedMD.
Experience evaluating patient financial eligibility.
Experience supporting Medicaid populations.
Provider credentialing or payer enrollment experience.
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
What Success Looks Like
Success in this position requires strong ownership and follow-through.
The ideal candidate does not simply complete individual insurance tasks. You should be able to look at a pending patient case, determine what is preventing it from moving forward, identify the next action, complete the necessary follow-up, and continue managing the case until the appropriate resolution has been reached.
You will help ensure patients do not remain unnecessarily stuck in the enrollment process because of missing documentation, incomplete insurance requirements, pending authorizations, or administrative backlogs.
Originally posted on Himalayas