UR Coordinator

Assembly Health

4d • $22 - $25

About The Position

Assembly Health is seeking a meticulous, detail-oriented UR Coordinator to manage client insurance authorization processes for Spravato and TMS services. The coordinator ensures required clinical information and documentation—including medical necessity letters, progress notes, rating scales, and treatment plans—is submitted accurately and on time. The role works across providers, clinical staff, and billing teams, and tracks authorization requests, denials, appeals, and renewals. It also supports new customers during start-up by helping them navigate authorization processes and clinical documentation, while staying current on payer requirements and documentation standards.

Requirements

• At least 2 years of experience in medical prior authorization, utilization review, or billing; behavioral health or neuromodulation experience is preferred.
• 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.
• Comfort working with EHR systems, payer portals, and medical documentation.
• Exceptional organization and a demonstrated ability to manage multiple priorities and tight deadlines.
• Detailed and organized written and verbal communication skills.
• Ability to work independently and collaboratively with clinical and administrative staff.

Nice To Haves

• Experience with in-network and out-of-network authorization workflows.
• Prior work with REMS-certified treatment programs.

Responsibilities

• Obtain and manage prior authorizations for Spravato and TMS services from commercial and government insurance plans.
• Submit required clinical documentation in a timely manner, including medical necessity letters, progress notes, rating scales, and treatment plans.
• Review payer-specific medical policies to determine coverage criteria for Spravato and TMS.
• Coordinate with providers, clinical staff, and billing teams to ensure submitted information is complete and accurate.
• Track and follow up on authorization requests, denials, appeals, and renewals.
• Maintain detailed records of payer communications, submission timelines, and authorizations received.
• Support new customers in their start-up phase by helping them navigate 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.

Benefits

• Medical insurance
• Dental insurance
• Vision insurance
• 401(k)
• Paid time off
• Eligible employees may have the opportunity to participate in company bonus programs.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed