UR Coordinator

This is a Fully Remote Job About Our Client:The organization operates within the healthcare sector, focusing on behavioral health services involving Spravato and transcranial magnetic stimulation (TMS) treatments. It addresses the challenge of managing complex insurance authorization processes required for these specialized therapies, ensuring clients receive timely access to care. The organization serves patients under various insurance plans, including CMS, commercial payers, and MassHealth, illustrating its involvement in a regulated and evolving healthcare environment. About the Opportunity:The UR COORDINATOR role is essential for managing insurance authorization processes related to Spravato and TMS services. This position ensures the accurate and timely submission of clinical documentation necessary for insurance approvals. By coordinating with clinical and billing staff, the UR coordinator facilitates smooth authorization workflows, directly impacting the organization's ability to deliver specialized treatments efficiently. Responsibilities:Obtain and manage prior authorizations for Spravato and TMS services from commercial and government insurance plansEnsure timely submission of required clinical documentation, including medical necessity letters, progress notes, rating scales, and treatment plansReview payer-specific medical policies to determine criteria for Spravato and TMS coverageCoordinate with providers, clinical staff, and billing teams to ensure complete and accurate information is submittedTrack and follow up on authorization requests, denials, appeals, and renewalsMaintain detailed records of payer communication, submission timelines, and authorizations receivedSupport new customers in their start-up phase by assisting with authorization processes and clinical documentationStay current on changes in insurance requirements, payer policies, and clinical documentation standardsUndertake additional projects and tasks as assigned Requirements:Minimum 2 years of experience in medical prior authorization, utilization review, or billing, preferably in behavioral health or neuromodulationStrong working knowledge of medical necessity criteria for Spravato and TMS services, including CMS, commercial payer, and MassHealth guidelinesExperience with insurance carriers in Massachusetts and Rhode IslandProficiency with EHR systems, payer portals, and medical documentationExceptional organizational skills with ability to manage multiple priorities and deadlinesClear and detailed written and verbal communication skillsAbility to work independently and collaboratively with clinical and administrative teamsPreferred experience with in-network and out-of-network authorization workflowsPreferred prior work with REMS-certified treatment programs Pay Range and Compensation Package:Salary range of $22 to $25 USD per hourCompensation based on skills, experience, qualifications, location, and applicable employment lawsEligibility for company bonus programsComprehensive benefits package including medical, dental, vision, 401(k), and paid time off Benefits & Perks:Medical insuranceDental insuranceVision insurance401(k) Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin. Note:TalentHop is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.