UR Coordinator

Assembly Health

1d•$22 - $25

About The Position

We're seeking a meticulous UR Coordinator with a strong working knowledge of medical necessity criteria for Spravato and TMS services, including familiarity with CMS, commercial payer, and MassHealth guidelines. We are seeking a detail-oriented and highly knowledgeable UR Coordinator to join our team and manage the client insurance authorization processes. As a key team member, you will ensure timely submission of required clinical information and documentation, including medical necessity letters, progress notes, rating scales, and treatment plans. You will also work cross-functionally to coordinate with providers, clinical staff, and billing teams to ensure complete and accurate information is submitted in a timely manner. You will be organized and thorough by frequently tracking and following up on authorization requests, denials, appeals, and renewal.

Requirements

Minimum 2 years of experience in medical prior authorization, utilization review, or billing, preferably in behavioral health or neuromodulation
Strong working knowledge of medical necessity criteria for Spravato and TMS services, including 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

Nice To Haves

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 tracking and following 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
Take on additional projects and tasks as assigned.