[Hiring] Bilingual Back-Office Insurance & Prior Authorization @GoLean Health

Role Description

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.
• 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.

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

• 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

• 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