Back-Office Insurance

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.

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 escalation 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.

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.

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