UR Coordinator

🕒 October 22

🇺🇸 United States – Remote

💵 $22 - $25 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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Assembly Health

WebsiteLinkedInAll Job Openings

201 - 500 employees

💼 Consulting

📦 Logistics

🏥 Healthcare

Consulting • Logistics • Healthcare

Assembly Health is dedicated to elevating financial performance for healthcare providers through innovative revenue cycle management and back-office solutions. Their expert team and technology optimize processes, allowing healthcare organizations to focus on delivering quality patient care. With a comprehensive approach that includes analytics, compliance consulting, and staffing services, Assembly Health serves a wide array of physician specialties and long-term care communities across the United States.

📋 Description

• Obtain and manage prior authorizations for Spravato and TMS services from commercial and government insurance plans • Ensure timely submission of 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 submissions • Track and follow up on authorization requests, denials, appeals, and renewals • Maintain detailed records of payer communication, submission timelines, and authorizations received • Support new customers during their start-up phase by navigating authorization processes and clinical documentation • Stay current on insurance requirements, payer policies, and clinical documentation standards • Take on 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 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 • Proven 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 • Preferred experience with in-network and out-of-network authorization workflows • Preferred prior work with REMS-certified treatment programs

🏖️ Benefits

• Medical insurance • Dental insurance • Vision insurance • 401(k) • Paid time off • Opportunity to participate in company bonus programs • Comprehensive benefits package

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