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 clinical documents, including letters of medical necessity, progress notes, rating scales, and treatment plans.

• Evaluate payer-specific medical policies to ascertain the criteria for coverage of Spravato and TMS.

• Collaborate with providers, clinical personnel, and billing teams to guarantee complete and precise submissions.

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

• Maintain thorough records of communications with payers, submission timelines, and authorizations obtained.

• Assist new clients during their initial phase by navigating the authorization processes and clinical documentation requirements.

• Remain updated on insurance prerequisites, payer policies, and standards for clinical documentation.

• Undertake additional projects and responsibilities as assigned.

⛳️ Requirements

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

• Strong understanding of medical necessity criteria for Spravato and TMS services, including knowledge of CMS, commercial payer, and MassHealth guidelines.

• Experience with a diverse range of insurance carriers, particularly those specific to Massachusetts and Rhode Island.

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

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

• Excellent written and verbal communication skills, with a focus on detail and organization.

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

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

• Preferred background in 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