Medical Insurance Verification & Prior Authorization Specialist — US Behavioral Health

Part-Time to Start | Long-Term | Growth to Full-Time

$7–$10 USD/hour depending on experience

TRUBRIETY is a growing U.S.-based behavioral health practice providing outpatient and intensive outpatient treatment for mental health and substance use conditions.

We are looking for an experienced Medical Insurance Verification / Prior Authorization Specialist in the Philippines to join our team long-term.

This is not an entry-level general VA position. Applicants must have prior experience working with U.S. health insurance.

Schedule

Starting approximately:

4 hours/day, 3 days/week — approximately 12 hours/week

We expect this position to grow toward 20–40 hours/week as our patient volume increases.

Some working hours must overlap with U.S. Pacific Time business hours because you will need to call insurance companies and work with payer portals.

Your First Responsibility: Insurance Benefits Verification

You will help make sure every new insured patient is financially cleared before treatment whenever possible.

For each patient, you will verify and document:

• Active insurance coverage
• In-network/out-of-network status
• Behavioral health benefits
• Mental health and substance use benefits
• Deductible and amount met
• Out-of-pocket maximum and amount met
• Copay
• Coinsurance
• Coverage for anticipated services
• Whether prior authorization is required
• Authorization requirements
• Visit/day limits
• Payer representative name
• Call/reference number
• Important exclusions or coverage issues

You will enter this information accurately into SimplePractice and our insurance tracking system.

Our goal is to clearly know where every patient stands:

Benefits Verified → PA Required/Not Required → PA Submitted → PA Approved → Ready for Services/Billing

As You Grow Into the Position

Your responsibilities may expand to include:

Prior Authorization

• Initiating prior authorization requests
• Submitting administrative information and clinical documentation provided by our clinical team
• Calling insurance companies for authorization status
• Following up on pending authorizations
• Tracking authorization numbers
• Tracking approved visits/days
• Tracking start/end dates and expiration dates
• Identifying additional information requested by payers
• Alerting us before authorizations expire

Claims / Revenue Cycle Support

• Checking claim status
• Researching unpaid claims
• Researching denials
• Identifying missing information
• Calling payers regarding claim issues
• Documenting payer responses and reference numbers
• Coordinating findings with our billing specialist
• Maintaining outstanding-claim and follow-up lists

Credentialing / Payer Enrollment

• Tracking provider credentialing
• Following up with payer credentialing departments
• Maintaining provider documentation
• Tracking licenses and expiration dates
• Assisting with CAQH and payer roster administration
• Supporting payer enrollment processes

Back-Office Operations

• Auditing SimplePractice for missing insurance information
• Maintaining authorization trackers
• Maintaining insurance-clearance reports
• Organizing payer correspondence
• Following up on outstanding administrative tasks
• Creating concise weekly status reports
• Helping us improve and document repeatable workflows

Strongly Preferred Experience

We are especially interested in candidates who have worked for:

• UHC / UnitedHealthcare
• Optum
• Blue Cross Blue Shield
• Regence
• Aetna
• Cigna
• Kaiser
• Carelon
• Elevance
• U.S. medical billing companies
• Healthcare BPOs serving U.S. providers

Experience with behavioral health, mental health, substance use treatment, IOP, or outpatient behavioral health is highly desirable.

Experience with any of the following is a plus:

• SimplePractice
• Availity
• Provider portals
• Prior authorization portals
• CAQH
• CPT / HCPCS codes
• S9480
• H0015
• 90834
• 90837
• 90853

You Should Already Understand

You should be comfortable with terms such as:

• Deductible
• Copay
• Coinsurance
• Out-of-pocket maximum
• In-network / out-of-network
• Eligibility
• Prior authorization
• Medical necessity
• Authorization dates
• Visit limits
• Claims
• Denials
• CPT / HCPCS codes

We do not expect you to make clinical decisions or independently determine coding. We do expect you to identify discrepancies, investigate them, document what the payer tells you, and know when something should be escalated.

What We Are Looking For

You should be:

• Extremely detail-oriented
• Organized
• Persistent
• Reliable
• Comfortable calling U.S. insurance companies
• Strong in spoken and written English
• Comfortable spending time on hold and following through until an issue is resolved
• Able to document payer conversations accurately
• Comfortable asking questions when something does not make sense
• Able to distinguish between an administrative issue you can investigate and an issue that needs escalation
• Interested in growing into a larger healthcare operations role

This position involves protected health information. You must be comfortable following strict HIPAA, confidentiality, privacy, and information-security requirements.

Technology Requirements

You must have:

• Reliable high-speed internet
• A quiet and private workspace
• Reliable computer
• Headset suitable for U.S. payer calls
• Backup internet connection
• A reasonable backup plan for power interruptions

Compensation

$8–$10 USD/hour to start depending on directly relevant experience.

There will be opportunities for increased hours, responsibility, and compensation as the company grows and you demonstrate the ability to independently manage these workflows.

How to Apply

Please do not send a generic application.

Start your application with the words:

TRUBRIETY INSURANCE

Then answer the following:

1. How many years have you worked with U.S. healthcare insurance?
2. Describe your experience performing insurance eligibility and benefit verification.
3. Describe your experience with prior authorization.
4. Which U.S. insurance companies have you worked with?
5. Which payer portals have you used?
6. Have you worked in behavioral health, mental health, addiction treatment, or IOP?
7. What EHR/EMR systems have you used?
8. Have you worked with SimplePractice?
9. What is your requested hourly rate?
10. What hours are you available in U.S. Pacific Time?
11. What is your primary internet connection and backup internet/power plan?

Please also answer this scenario

A behavioral health patient has Regence insurance.

The benefit check shows:

• $1,500 deductible
• Deductible has not yet been met
• 20% coinsurance after the deductible
• The payer representative says S9480 is not covered
• The patient reports that Regence previously authorized IOP treatment at another facility

Before telling the practice that IOP is not covered, what would you investigate and document?

Please explain your process.

Important

We are looking for someone who wants a long-term position and an opportunity to grow with the company, not someone looking for a temporary freelance project.