RCM Specialist - Prior Authorization (Behavioral Health/Psychiatry)

2070Health; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare organization is seeking an RCM Specialist specializing in prior authorization workflows for interventional psychiatry. This position requires extensive experience in managing insurance approvals for psychiatric treatments, with a focus on TMS and Spravato. Join a mission-driven team dedicated to enhancing access to behavioral health services.

Qualifications

• Minimum 6 years of hands-on experience in RCM/PAR workflows.
• Strong familiarity with insurance guidelines for TMS and Spravato.
• Proven ability with clinical documentation and payer communication.

Responsibilities

• Prepare, submit, and track prior authorization requests for TMS and Spravato.
• Review medical records to extract documentation for approvals.
• Coordinate with teams for obtaining missing information and following up on authorizations.

Skills

Attention to detail

Time management

English communication

Tools

EMR systems

Prior auth submission platforms

Job description

About Careforce

Careforce is reimagining outpatient care. Backed by a multi-million-dollar seed round from W Health Ventures and incubated by 2070 Health, we're building a next-gen Holdco of asset-light MSOs, purpose-built for physician-led specialty practices. Our platform is designed to streamline operations, enhance clinical quality, and accelerate growth. We're starting with Interventional Psychiatry-bringing modern infrastructure, operational excellence, and scalable support.

About the Role

We are seeking a detail-oriented and experienced RCM Specialist with a strong background in Prior Authorization (PAR) workflows within the behavioral health domain, specifically interventional psychiatry services such as Transcranial Magnetic Stimulation (TMS) and Spravato (Esketamine).

This is a clinical-facing administrative role that involves processing complex prior authorizations that require understanding clinical documentation, payer requirements, and the nuances of behavioral health treatment protocols.

Key Responsibilities

• 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

Qualifications

• 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

Preferred Experience

• 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

Why Join Careforce

You’ll be working in a mission-driven environment that aims to improve access to innovative psychiatric care. This role offers long-term potential and the opportunity to be an integral part of a growing RCM team specialized in behavioral health.