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…