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

Role Description

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.
• 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.

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.

Requirements

• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.

Benefits

• Remote work opportunity.
• Flexible working hours (30 hours/week).
• Competitive pay ($5-$6/hour).

Company Description

We are a nonprofit behavioral health organization dedicated to providing quality care to our patients.