UR Coordinator

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

Become an Assembler! If you are looking for a company that is focused on being the best in the industry, love being challenged, and make a direct impact on our business, then look no further! We are adding to our motivated team that pride themselves on being client-focused, biased to action, improving together, and insistent on excellence and integrity.

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.