RCM Benefits Verification / Prior Authorization Specialist
Osmind
This job is no longer accepting applications
See open jobs at Osmind.See open jobs similar to "RCM Benefits Verification / Prior Authorization Specialist" General Catalyst.Accounting & Finance
United States
What You'll Do
- Prior Authorization
- Review patient medical records and insurance information to determine authorization requirements
- Coordinate with practices and insurance companies to obtain pre-authorization for medical procedures, treatments, and medications
- Maintain current knowledge of insurance policies, regulations, and requirements to ensure compliance
- Communicate with patients and healthcare providers regarding documentation requirements, authorization status, and coverage changes
- Benefits Verification
- Gather necessary information to verify benefits insurance coverage, navigate behavioral health benefit complexities such as carveouts
- Leverage technology tools and payer phone calls to efficiently and accurately verify and investigate benefits for patients
- Maintain detailed records of insurance verification activities and statuses
- Strategic & Operational Support
- Provide expert guidance on mental health front-end processes, with a specific focus on complex treatments like TMS and Spravato
- Directly interface with clinic owners, practice managers, and billing partners, and provide support and best practice guidance
- Propose process enhancements, automation, or system improvements to streamline operations and enhance the overall effectiveness of benefits verification and prior authorization activities
- Collaborate effectively with back-end RCM team members to identify and address any issues
- Stay current on industry trends, regulatory changes, and payer policies impacting mental health billing
Required Experience
- 3+ years of experience in healthcare revenue cycle management with demonstrated expertise in both prior authorization and benefits verification
- Demonstrated expertise with Spravato benefits verification and prior authorization - this is absolutely essential
- Excellent research, communication, organization, and problem-solving skills
- Proficiency in EHR systems and practice management software
- Ability to work independently and collaboratively in a fast-paced environment
- Self-starter mentality with adaptability to new technologies
Nice to Haves
- Experience working in or consulting for an MSO or large psychiatric practice group
- Experience with TMS and other interventional psychiatric treatments
- Excitement to adopt technology and AI to automate benefits verification and prior authorization processes
- Experience with data analytics tools and generating actionable insights from RCM data
This job is no longer accepting applications
See open jobs at Osmind.See open jobs similar to "RCM Benefits Verification / Prior Authorization Specialist" General Catalyst.