RCM Prior Authorization Specialist
Osmind
This job is no longer accepting applications
See open jobs at Osmind.See open jobs similar to "RCM Prior Authorization Specialist" General Catalyst.
United States
Posted 6+ months ago
About Us
Osmind is a technology, services, and data company focused exclusively on psychiatry. Mental health disorders are one of the leading causes of death worldwide and are tied to shortening lifespans. Yet, we have cause for hope: there have been developments in new psychiatric medications since the first FDA approval in 1954, such as new treatments like ketamine, Spravato, and neuromodulation. Now, there is a growing movement among clinicians, patients, and researchers to close the gap between this scientific innovation and better real-world care.
At Osmnid, we serve a network of 800+ independent psychiatry practices across 49 states. We help these clinics effectively provide high-quality care, scale as businesses, and contribute to research with our purpose-built EHR, software solutions, clinician community, and managed services. Our providers are at the forefront of psychiatry, offering innovative interventions and treating some of the highest acuity patients in the country.
Osmind is a San Francisco–based public benefit corporation backed by top investors including DFJ Growth, Future Ventures, General Catalyst, and Y Combinator.
Role Overview
The primary role of Prior Authorization Specialist is to serve as the subject matter expert navigating the complexities of prior authorization and insurance verification. Individuals who succeed in this role will demonstrate the ability to decipher insurance jargon with ease, understand healthcare regulations, and have the ability to properly research issues with insurance carriers.
Key Responsibilities
- Maintain current knowledge of insurance policies, regulations, and requirements to ensure compliance with industry standards
- Ability to meet productivity and quality measurement requirements
- Work collaboratively with internal and extended business office staff
- Review patient medical records and insurance information to determine which services require authorization
- Coordinate with the practices and insurance companies to obtain pre-authorization for medical procedures, treatments, and medications
- Communicate with patients and healthcare providers regarding the status of authorization requests and any changes in coverage
- Participate in the development of coding and billing strategies, evaluating processes related to Revenue Cycle and making recommendations while ensuring compliance with any relevant rules or regulations (including HIPAA, Medicaid, Medicare, and specific third-party payers)
- Maintains professional relationships and collaborates across teams
- Prepares and coordinates revenue cycle responsibilities within the acquisition/implementation process. This includes but is not limited to staff onboarding, vendor management, and clearinghouse management.
Required Qualifications
- 3+ years of experience in prior authorization and insurance verification
- Deep understanding of CPT coding, insurance claim processing, and payer reimbursement models
- Demonstrated expertise with services like TMS, Spravato, and other interventional psychiatric treatments
- Excellent research and comprehension skills for behavioral healthcare regulations
- Adaptability and comfort with new technologies
- Ability to work independently, collaboratively, and reliably
- Self-starter mentality with a problem-solving approach
- Thrives in a dynamic environment and welcomes new challenges
Preferred Qualifications
- Experience working in or consulting for an MSO or large psychiatric practice group
- Familiarity with value-based care models and alternative payment structures in mental health
- Knowledge of healthcare compliance regulations (e.g., HIPAA, Stark Law)
- Experience with data analytics tools and generating actionable insights from RCM data
A Successful First Year Might Look Like...
- Onboarding and optimizing RCM processes for multiple psychiatric clinics, resulting in an improvement in collection rates
- Developing and implementing best practices for TMS and Spravato billing that reduce denial rates
Location
This role will be based in the United States with minimal travel required.
This is a unique opportunity to help build a transformative healthcare organization from the ground up while solving critical challenges for psychiatric providers and their patients. The successful candidate will play a key role in shaping the future of mental healthcare delivery.
This job is no longer accepting applications
See open jobs at Osmind.See open jobs similar to "RCM Prior Authorization Specialist" General Catalyst.
