Prior Authorization Specialist - TMS Services

The Role You will primarily manage the prior authorization lifecycle for: Transcranial Magnetic Stimulation (TMS) services Related psychiatric treatment authorizations when applicable You will also support operational coordination related to the organization’s SPRAVATO® program, including: Medication delivery coordination Treatment readiness verification Communication with pharmacies and internal clinical teams This role works closely with: Providers TMS teams Revenue Cycle Clinical Operations Patient Access teams Specialty pharmacies and insurance carriers Your work directly impacts: Treatment readiness Scheduling continuity Authorization turnaround times Patient access to advanced mental healthcare Prior Authorization Management Submit, track, and manage prior authorizations for TMS and SPRAVATO® services Verify insurance eligibility, benefits, and coverage criteria Gather and organize required clinical documentation for submission Monitor authorization approvals, expiration dates, visit limits, and renewals Escalate urgent authorization barriers appropriately and proactively Insurance & Payor Coordination Communicate directly with commercial insurance carriers, managed care organizations, and pharmacy benefit managers Navigate payer‑specific medical necessity criteria and authorization requirements Resolve pending cases, denials, and documentation deficiencies efficiently Support appeals and reconsideration workflows when necessary Clinical & Operational Collaboration Coordinate closely across clinical and operational teams to ensure authorization readiness aligns with scheduling and treatment timelines Maintain accurate documentation within EHR systems and operational tracking tools Help reduce delays between psychiatric evaluation, approval, and treatment initiation SPRAVATO® Coordination Support Coordinate medication delivery timelines with specialty pharmacies Confirm treatment readiness and delivery status prior to scheduled appointments Communicate with clinical and operational teams regarding medication logistics and scheduling alignment Maintain organized tracking and documentation related to treatment coordination Documentation & Compliance Maintain precise records of: Authorization approvals Reference numbers Insurance communication Coverage limitations Renewal timelines Ensure HIPAA compliance and confidentiality standards at all times Support operational reporting and audit readiness initiatives What We’re Looking For Required 2+ years of prior authorization experience within healthcare Experience navigating payer portals, insurance verification, and authorization workflows Strong understanding of medical terminology and healthcare operations Exceptional organizational skills and follow-through Ability to manage multiple cases simultaneously without sacrificing accuracy Proficiency with EHR/EMR systems and Microsoft Office or Google Workspace Strong communication and documentation skills Preferred Behavioral health or psychiatry experience Familiarity with: TMS workflows Specialty medications Pharmacy coordination Appeals and denial management Experience working with Medicare and commercial behavioral health plans What Success Looks Like Successful Prior Authorization Specialists at My Psychiatrist: Operate with structure and consistency Move quickly without creating operational errors Anticipate authorization barriers before they delay care Maintain organized, audit-ready documentation Communicate clearly across clinical and operational teams Protect patient access through operational excellence and follow‑through You understand that every authorization represents something larger than paperwork: a patient waiting for relief. What You’ll Find Here Competitive compensation Medical, dental, and vision insurance 401(k) with company match PTO + paid holidays Structured onboarding and operational support Professional growth opportunities within a rapidly scaling organization A physician‑led environment focused on quality, accountability, and innovation Apply If you thrive in structured environments, value accountability, and want your work to directly impact access to advanced mental healthcare— See yourself here? Let’s talk. Reach out directly: View email address on click.appcast.io #J-18808-Ljbffr My Psychiatrist, LLC