RCM Benefits Verification – Prior Authorization Specialist

🔥 0 minutes ago

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Osmind

WebsiteLinkedInAll Job Openings

51 - 200 employees

⚕️ Healthcare Insurance

☁️ SaaS

🤖 Artificial Intelligence

Healthcare Insurance • SaaS • Artificial Intelligence

Osmind is a leading provider of electronic health record (EHR) software and services specifically tailored for psychiatric practices and ketamine treatment clinics. The company supports a network of over 800 independent psychiatry practices and collaborates with life sciences companies to enhance mental health treatment and research. Osmind's platform helps clinicians streamline workflow, track robust outcomes, and facilitate patient engagement with modern psychiatry interventions such as TMS and SPRAVATO®. Their state-of-the-art EHR system simplifies practices for clinicians, making it easier for them to manage psychiatric medications and interventions. Osmind is at the forefront of advancing evidence-generating medicine, helping to set new standards for mental health interventions.

📋 Description

• Conduct thorough phone and portal-based benefit verifications. Once a patient is confirmed as clinically appropriate, you own the VOB from start to finish. • Determine the details automated checks miss — medical vs. pharmacy routing, code-level coverage, exact deductible/OOP status, coinsurance, coordination of benefits, and prior authorization requirements. • Translate VOB findings into a clear, actionable summary for the practice. No jargon, no ambiguity — the practice should be able to act on your output without follow-up questions. • Own the full PA lifecycle for Spravato, TMS, and other treatments: initial submission through approval, with proactive re-authorization so there are never gaps in care. • Select the right submission channel based on payer and treatment type (CoverMyMeds, Availity, payer-specific portals, fax/phone where needed). • Monitor status actively. Follow up before things get stuck. On denial, identify the cause and coordinate appeals or peer-to-peer requests with the practice. • Understand what each payer requires and confirm clinical documentation supports medical necessity before submission. • When a VOB or PA response doesn't add up, you investigate — you don't just document and move on. • Call payers back with targeted questions. Cross-reference portal data with phone results. Identify whether the issue is a data error, a policy misapplication, or a legitimate coverage limitation. • Escalate with context: when you bring an issue to the team, you've already done the legwork. • Write clear, concise, professional messages to practices. Every benefit summary, PA update, and denial communication should be something a provider can act on without a follow-up call. • Be the calm, organized voice when a payer outcome is confusing or frustrating. Your follow-through and communication quality are what make a practice feel they're in the best possible hands. • Manage your own queue. Flag expiring authorizations before they expire. Raise blockers promptly and specifically — don't sit on problems. • Pick up new platforms quickly and independently. All internal tools are proprietary — you won't have used them before, and that's expected. What we need is the confidence and resourcefulness to learn them.

🎯 Requirements

• 2+ years of hands-on experience in benefit verification and prior authorization (not just claims or cash posting) • Strong command of VOB vocabulary and mechanics: deductibles, coinsurance, OOP maximums, medical vs. pharmacy routing, PBMs, coordination of benefits • End-to-end PA lifecycle experience: submission, status monitoring, denial management, appeals • Experience with major payer portals (Availity, Navinet, Optum, or payer-specific) and pharmacy PA platforms (CoverMyMeds or comparable) • Clear, professional written English — you can write a provider-facing message that needs zero edits • Demonstrated ability to learn new technology independently • US-based, remote-eligible

🏖️ Benefits

• healthcare • dental • vision • generous family leave • FSA/DCFSA • mental health benefits • 401(k) plan • flexible paid time off