Medical Billing & Prior Authorization Specialist

Job Title: Medical Billing & Prior Authorization Specialist
Position Type: Full-Time

Work Hours: 9:00 AM – 6:00 PM Central Time (with 1-hour unpaid lunch break)

Work Days: Monday – Friday

Weekend Availability: 1–2 hours on weekends, only as needed (Saturday and Sunday, around 1:00 PM Central Time, 1 hour each for follow-ups)

Salary: $5–7 per hour, depending on experience
Workplace: Remote

Preferred Candidate Location: Philippines

About the Role

Our Client is looking for an experienced and detail-oriented Medical Billing & Prior Authorization Specialist to join a well-established, US-based psychology and psychiatry practice.

The clinic provides comprehensive mental and behavioral healthcare services, including psychotherapy, psychological evaluations, neurofeedback, and Transcranial Magnetic Stimulation (TMS). With approximately six providers serving 30–50 patients daily, the practice is committed to delivering quality patient care while maintaining efficient administrative and billing operations.

The ideal candidate has hands-on experience with US healthcare insurance billing, claims processing, and prior authorizations. You will initially support the clinic's billing operations, including covering responsibilities during an existing team member's maternity leave, before transitioning into a long-term collaborative billing role.

This opportunity is ideal for someone who is organized, proactive, comfortable communicating with insurance companies and patients, and interested in growing within a healthcare practice.

Key Responsibilities

Medical Billing & Insurance Claims Processing (Top Priority)

• Manage and process approximately 20–30 US healthcare insurance claims daily, ensuring accurate and timely submissions.
• Review billing information, insurance coverage, provider details, and documentation before submitting claims.
• Identify and resolve billing discrepancies, rejected claims, and processing issues.
• Ensure accurate billing for services involving psychologists, psychiatrists, and doctoral interns, following applicable payer requirements.
• Coordinate with insurance companies to resolve claims-related concerns and maintain proper reimbursement workflows.

Prior Authorization Management

• Handle prior authorization requests for applicable behavioral health and psychiatric services.
• Verify insurance requirements, coverage limitations, and authorization status.
• Coordinate with providers, insurance companies, and internal staff to obtain necessary documentation.
• Track pending authorizations, follow up on outstanding requests, and prevent delays in patient services.
• Maintain accurate records of authorization approvals, denials, and expiration dates.

Billing Follow-Up & Administrative Support

• Follow up on unpaid, pending, rejected, or denied insurance claims.
• Contact insurance companies to clarify claim statuses, payment discrepancies, and billing requirements.
• Maintain organized billing records and track outstanding tasks.
• Assist in documenting billing procedures and improving administrative workflows.
• Collaborate with the existing billing specialist and clinical team to ensure continuity of billing operations.

Patient Communication & Clinic Coordination

• Conduct outreach and communicate with other clinics, insurance representatives, and patients as needed.
• Assist patients in understanding their insurance benefits, coverage, and billing responsibilities within the scope of the role.
• Provide general information about the clinic's services and assist with service-related inquiries.
• Handle inbound and outbound calls professionally using RingCentral.
• Support additional administrative responsibilities as assigned, with training provided.

Systems & Tools

• TherapyNotes: Current practice management and EHR platform.
• Tebra: Planned EHR transition in January 2027.
• RingCentral: Phone communication and coordination.
• Insurance payer portals: For eligibility verification, claims processing, prior authorizations, and follow-ups.

Requirements

Experience & Qualifications

• Must have previous hands-on experience with US healthcare insurance billing and claims processing. This is a non-negotiable requirement.
• Experience handling insurance claims submissions, billing follow-ups, and resolving claim discrepancies.
• Knowledge of prior authorization workflows, insurance eligibility, and benefits verification.
• Familiarity with US healthcare billing procedures, payer requirements, and insurance terminology.
• Strong attention to detail, particularly when reviewing provider information, billing responsibilities, and insurance documentation.
• Excellent organizational skills and ability to manage multiple tasks and deadlines independently.
• Strong verbal communication skills, with clear, easily understandable spoken English.
• Experience in psychology, psychiatry, or behavioral health billing is highly preferred.
• Experience using TherapyNotes, Tebra, RingCentral, or similar healthcare systems is an advantage.
• Previous experience working remotely or as a healthcare virtual assistant is preferred but not mandatory.
• A medical degree, nursing license, or other clinical license is not required.
• Willingness to learn additional administrative workflows and adapt to evolving clinic needs.

Basic Requirements

• Must be proficient in speaking and writing English clearly and professionally.
• Must have relevant US healthcare billing experience.
• Must be comfortable communicating with US patients, insurance representatives, and healthcare professionals.
• Must be able to submit an NBI Clearance and/or Local Police Clearance before onboarding (mandatory).
• Must be available for video meetings with the camera on when required.
• Must be willing to work US Central Time business hours and accommodate occasional weekend follow-ups when necessary.
• Must demonstrate professionalism, confidentiality, reliability, and the ability to work independently.
• Must be able to follow HIPAA guidelines and maintain patient information confidentiality

Technical Requirements

• Computer: Reliable laptop or desktop computer.
• Internet: Stable high-speed internet connection (minimum 25 Mbps).
• Audio: Noise-canceling headset.
• Video: Working webcam for virtual meetings.
• Workspace: Quiet and professional work environment.

Benefits

• Dedicated HR & Contractor Support Team: Access to world-class support for questions, guidance, contract matters, and client communication.
• Premium VPN Access (Optional): A secure VPN license can be provided upon request to enhance privacy and security for client-related tasks.
• HIPAA & Cybersecurity Training + Certification (Provided): Access to our internal HIPAA compliance training, cybersecurity modules, and certification to help you confidently handle PHI for U.S. healthcare clients.
• Top 1% VA Performance Training: Access to our proprietary training on communication, client management, productivity systems, and best practices to help you become a top-performing VA and increase long-term client retention.
• Client-Approved U.S. Holidays: Contractors may take U.S. holidays off according to the client’s needs and schedule.
• Client-Approved Paid or Unpaid Time Off: Time off may be granted by your client. Paid time off is optional and only if offered by the client.
• Access to Tools & Resources: Templates, workflow guides, productivity tools, and client-specific SOP support to help you perform at your best.
• Optional Performance-Based Incentives: Some clients may offer bonuses, incentives, or increased hours based on your performance.

These are optional resources and client-approved allowances available to you as an independent contractor. Any resources, training, or allowances listed are optional contractor perks and not employee benefits.