RCM Prior Authorization Specialist - Remote

Overview

The primary role of Prior Authorization Specialist is to serve as the subject matter expert navigating the complexities of prior authorization and insurance verification.

In Short

• Maintain current knowledge of insurance policies, regulations, and requirements.
• Meet productivity and quality measurement requirements.
• Work collaboratively with internal and extended business office staff.
• Review patient medical records and insurance information.
• Coordinate with practices and insurance companies for pre-authorization.
• Communicate with patients and healthcare providers regarding authorization requests.
• Participate in coding and billing strategy development.
• Maintain professional relationships and collaborate across teams.
• Prepare and coordinate revenue cycle responsibilities.

Requirements

• 3+ years of experience in prior authorization and insurance verification.
• Deep understanding of CPT coding and payer reimbursement models.
• Expertise with TMS, Spravato, and interventional psychiatric treatments.
• Excellent research and comprehension skills.
• Adaptability with new technologies.
• Ability to work independently and collaboratively.
• Self-starter mentality with a problem-solving approach.
• Thrives in a dynamic environment.

Benefits

• Onboarding and optimizing RCM processes for clinics.
• Implementing best practices for TMS and Spravato billing.