Offer summary

Qualifications:

3+ years of experience in prior authorization and insurance verification, Deep understanding of CPT coding and insurance claim processing, Excellent research and comprehension skills for behavioral healthcare regulations, Ability to work independently and collaboratively in a dynamic environment..

Key responsabilities:

Maintain knowledge of insurance policies and ensure compliance with industry standards

Review patient medical records to determine services requiring authorization

Coordinate with practices and insurance companies for pre-authorization of medical procedures

Communicate with patients and healthcare providers regarding authorization request statuses.

Job description

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.

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