UR Coordinator

This is a fully remote position, open to applicants in United States.

📋 Description

• Acquire and oversee prior authorizations for Spravato and TMS services from both commercial and government insurance providers.

• Ensure the prompt submission of necessary clinical documentation, such as medical necessity letters, progress notes, rating scales, and treatment plans.

• Examine payer-specific medical policies to assess criteria for Spravato and TMS coverage.

• Collaborate with providers, clinical staff, and billing teams to guarantee that complete and accurate information is submitted.

• Monitor and follow up on authorization requests, including denials, appeals, and renewals.

• Keep meticulous records of payer communications, submission timelines, and received authorizations.

• Assist new customers during their onboarding phase by guiding them through the authorization processes and clinical documentation requirements.

• Remain informed about changes in insurance requirements, payer policies, and standards for clinical documentation.

• Undertake additional projects and tasks as assigned.

⛳️ Requirements

• At least 2 years of experience in medical prior authorization, utilization review, or billing, preferably within behavioral health or neuromodulation.

• Strong understanding of medical necessity criteria relevant to Spravato and TMS services.

• Familiarity with CMS, commercial payer, and MassHealth regulations.

• Experience with a variety of insurance carriers, including those specific to Massachusetts and Rhode Island.

• Proficient in working with EHR systems, payer portals, and medical documentation.

• Demonstrated ability to handle multiple priorities and meet tight deadlines.

• Strong written and verbal communication skills, with attention to detail and organization.

• Capability to work both independently and collaboratively with clinical and administrative teams.

• Preferred experience in handling in-network and out-of-network authorization workflows.

• Preferred background with REMS-certified treatment programs.

🏝️ Benefits

• Medical insurance

• Dental insurance

• Vision insurance

• 401(k)

• Paid time off

• Opportunity to participate in company bonus programs

• Comprehensive benefits package