Prior Authorization Specialist – Spravato & TMS

Assembly Health; United States; On-site; USD 30,000 - 34,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k)

Paid time off

Job summary

Assembly Health seeks a meticulous UR Coordinator with strong knowledge of medical necessity criteria for Spravato and TMS. You will manage client insurance authorizations, ensure timely submission of clinical information, and collaborate with providers, clinical staff, and billing teams.

Responsibilities include obtaining prior authorizations, reviewing payer policies, maintaining records, and supporting new customers during startup. Strong organizational skills and independence are essential.

Qualifications

• 2+ years of medical prior authorization, utilization review, or billing experience.
• Strong knowledge of medical necessity criteria for Spravato and TMS.
• Experience with Massachusetts and Rhode Island carriers is a plus.
• Familiar with EHR systems and payer portals; detail-oriented and organized.

Responsibilities

• Obtain and manage prior authorizations for Spravato and TMS services from commercial and government plans.
• Submit required clinical documentation: medical necessity letters, progress notes, rating scales, treatment plans.
• Review payer policies to determine Spravato and TMS coverage criteria.
• Coordinate with providers, clinical staff, and billing teams for complete information.
• Track and follow up on authorizations, denials, appeals, and renewals.
• Maintain detailed records of payer communication and submission timelines.
• Support new customers navigating authorization processes during startup.
• Stay current on insurance requirements and clinical documentation standards.
• Take on additional projects as assigned.

Skills

Prior authorization

Utilization review

Billing

EHR systems

Payer portals

Attention to detail

Tools

Payer portals

Job description

Assembly Health seeks a meticulous UR Coordinator with strong knowledge of medical necessity criteria for Spravato and TMS. You will manage client insurance authorizations, ensure timely submission of clinical information, and collaborate with providers, clinical staff, and billing teams.

Responsibilities include obtaining prior authorizations, reviewing payer policies, maintaining records, and supporting new customers during startup. Strong organizational skills and independence are essential.