RCM Specialist
2 weeks ago
- Prepare, submit, and track prior authorization requests for behavioral health treatments including TMS, Spravato, and other psychiatric interventions
- Review medical records and clinical notes to extract relevant documentation required for insurance approval
- Understand and apply payer-specific guidelines (including Medicare, Medicaid, and commercial carriers) for psychiatric services
- Coordinate with onshore teams to obtain missing information and clarify clinical documentation
- Follow up on submitted authorizations to ensure timely approvals or manage denials
- Maintain accurate records in practice management or EMR systems and payer portals
- Communicate professionally with internal stakeholders regarding the status and next steps for each case
- Minimum 6 years of hands-on experience in RCM/PAR workflows within the U.S. behavioral health or interventional psychiatry space
- Strong familiarity with insurance guidelines for TMS, Spravato, and similar interventions
- Proven ability to work with clinical documentation, including reviewing physician notes and extracting key information for payers
- Experience using EMR and prior auth submission platforms (e.g., Availity, CoverMyMeds, payer portals)
- Excellent attention to detail and time management in a fast-paced setting
- Strong written and verbal English communication skills
- Exposure to U.S. Medicare LCDs or medical necessity criteria for psychiatric procedures
- Experience working with U.S. based teams or clinicians
- Familiarity with appeals and peer-review processes for denied authorizations
2070 Health
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