Job Description

Job Title: MENTAL HEALTH Precertification Specialist for TMS and Spravato

Overview:

As a TMS and Spravato Precertification Specialist, your primary responsibility will be to ensure the smooth and efficient process of obtaining preauthorization and precertification for transcranial magnetic stimulation procedures and Spravato. TMS is a non-invasive neurostimulation technique used to treat various neurological and psychiatric conditions. In this role, you will collaborate with medical staff, insurance companies, and patients to navigate the precertification process and ensure timely approval for TMS and Spravato treatments .

Spravato

(esketamine) is a prescription nasal spray used to treat

treatment-resistant depression

in adults. It works differently from traditional antidepressants by targeting glutamate receptors in the brain. Spravato is taken under medical supervision, usually in a clinic, due to its potential side effects and risk of misuse.

Duties:

Insurance Coordination:

Work closely with healthcare providers and insurance companies to gather and submit the necessary documentation for TMS procedure preauthorization.

Doctor Communication:

Communicate with doctors or doctor's office to explain the precertification process, provide information about insurance coverage, and assist in gathering required medical records.

Documentation:

Maintain accurate and up-to-date records of patient information, medical documentation, and insurance correspondence related to precertification.

Review and Verification:

Review patient medical histories, diagnoses, and treatment plans to ensure alignment with insurance requirements for precertification.

Submission of Requests:

Prepare and submit preauthorization requests to insurance companies, following established protocols and guidelines.

Follow-up:

Track the progress of preauthorization requests and follow up with insurance companies to expedite the approval process.

Problem Resolution:

Address any issues, denials or discrepancies that may arise during the precertification process and work collaboratively with medical staff, insurance representatives, and doctors to resolve them.

Compliance:

Ensure adherence to all relevant regulations, guidelines, and policies related to TMS procedures, patient information, and insurance procedures.

Data Management:

Maintain a well-organized database of patient information, insurance contacts, and precertification outcomes.

Reporting:

Generate regular reports summarizing the status of precertification requests, approvals, and denials for review by relevant stakeholders.

Familiarity with medical terminology, insurance procedures, and healthcare regulations. Strong communication skills, both written and verbal. Excellent organizational and time-management abilities. Attention to detail and accuracy in record-keeping.

Qualifications:

Must be a self-starter, able to work responsibly and independently.

Previous experience in medical office administration and insurance precertification, Insurance verification and Healthcare customer service.

Familiarity with medical terminology, insurance procedures, and healthcare regulations.

Strong communication skills, both written and verbal.

Excellent organizational and time-management abilities.

Attention to detail and accuracy in record-keeping.

Must be a fast learner

Excellent in speaking and understanding English

Must have in-depth understanding of the US Healthcare System

Joining our team as a Specialist offers the opportunity to work in a dynamic environment where your skills and expertise will be valued. If you are looking to make a meaningful impact in the MENTAL HEALTH industry, we encourage you to apply.

Job Type: Full-time

Pay: From
87,000.00 per month

Benefits:

Work from home
Schedule:

Monday to Friday
Supplemental Pay:

Overtime pay * Yearly bonus