UR Coordinator
New
A
Assembly HealthBehavioral Health
RemoteFull-TimeMiddle
Salary$22 — $25 USD
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Job Details
- Experience
- Minimum 2 years of experience in medical prior authorization, utilization review, or billing
- Required Skills
- EHR
Requirements
- Minimum 2 years of experience in medical prior authorization, utilization review, or billing
- Strong working knowledge of medical necessity criteria for Spravato and TMS services
- Familiarity with CMS, commercial payer, and MassHealth guidelines
- Experience with a wide range of insurance carriers, including Massachusetts and Rhode Island-specific carriers
- Comfortable working with EHR systems, payer portals, and medical documentation
- Exceptionally organized, with proven ability to manage multiple priorities and tight deadlines
- Detailed and organized communication skills, both written and verbal
- Ability to work independently and collaboratively with clinical and administrative staff
- Preferred experience with in-network and out-of-network authorization workflows
- Preferred prior work with REMS-certified treatment programs
Responsibilities
- Obtain and manage prior authorizations for Spravato and TMS services from commercial and government insurance plans
- Ensure timely submission of required clinical documentation, including medical necessity letters, progress notes, rating scales, and treatment plans
- Review payer-specific medical policies to determine criteria for Spravato and TMS coverage
- Coordinate with providers, clinical staff, and billing teams to ensure complete and accurate information is submitted
- Frequently track and follow up on authorization requests, denials, appeals, and renewals
- Maintain detailed records of payer communication, submission timelines, and authorizations received
- Provide support to new customers who are in their start-up phase by navigating authorization processes and clinical documentation
- Stay current on changes in insurance requirements, payer policies, and clinical documentation standards
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