Provider Credentialing

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 escalade 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 administ