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RCM Specialist - Prior Authorization (Behavioral Health / Psychiatry)

xponentiateIN

30+ days ago

Job type

Remote

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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.

Requirements

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

Requirements

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

Benefits

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.

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