UR Coordinator

UR Coordinator

We're seeking a meticulous UR Coordinator with a strong working knowledge of medical necessity criteria for Spravato and TMS services, including familiarity with CMS, commercial payer, and MassHealth guidelines.

We are seeking a detail-oriented and highly knowledgeable UR Coordinator to join our team and manage the client insurance authorization processes. As a key team member, you will ensure timely submission of required clinical information and documentation, including medical necessity letters, progress notes, rating scales, and treatment plans. You will also work cross-functionally to coordinate with providers, clinical staff, and billing teams to ensure complete and accurate information is submitted in a timely manner. You will be organized and thorough by frequently tracking and following up on authorization requests, denials, appeals, and renewal.

What You Will Do

• Obtain and manage prior authorizations for Spravato and TMS services from commercial and government insurance plans
• Ensure timely submission of required 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 information is submitted
• Frequently tracking and following up on authorization requests, denials, appeals, and renewals
• Maintain detailed records of payer communication, submission timelines, and authorizations received
• Provide support to new customers who are in their start-up phase by navigating 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.

What it Takes to Join the Family

• 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
• Exceptionally organized, with proven ability to manage multiple priorities and tight deadlines
• Detailed and organized communication skills, both written and verbal
• 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

Salary Range $22 —$25 USD

Compensation for this role is based on a variety of factors, including but not limited to, skills, experience, qualifications, location, and applicable employment laws. The expected salary range for this position reflects these considerations and may vary accordingly. In addition to base pay, eligible employees may have the opportunity to participate in company bonus programs. We also offer a comprehensive benefits package, including medical, dental, vision, 401(k), paid time off, and more.

All official recruitment communications from Assembly Health will originate from an @assembly.health email address. Candidates are encouraged to carefully verify sender domains and remain vigilant against potential impersonation attempts. Communications from any other domain should be considered unauthorized.