Remote Prior Authorization Rn Jobs in Charleston, WV

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 shortened life expectancies. Yet, we have cause for hope: there have been landmark developments in psychiatric medications and treatments — including ketamine, Spravato, and neuromodulation — and a growing movement among clinicians, patients, and researchers to close the gap between scientific innovation and real-world care.

At Osmind, we serve a network of 1,000+ independent psychiatry practices across the country. We help these clinics provide high-quality care, scale as businesses, and contribute to research through our purpose-built EHR, software solutions, and managed services. Our providers are at the forefront of psychiatry, 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.

The Benefit Verification & Prior Authorization (BV & PA) Specialist is one of the most vital roles in our RCM operation. Accurate, timely BV and PA work is the foundation on which everything downstream is built — patient financial estimates, claim submission, denial avoidance, and cash flow. When it's wrong, the consequences cascade.

It's also the practice's first exposure to Osmind RCM. The way you handle a benefit verification or a prior authorization — through approval, through re-authorization, through any bumps along the way — is what tells a practice they're working with the best in the industry for interventional psychiatry. This is a white-glove role, and you set the tone.

You will own the full BV and PA lifecycle for Spravato, TMS, and other interventional treatments: phone- and portal-based verification, end-to-end PA submission and follow-up, and clear written communication back to the practice so patients can be scheduled with confidence.

This is a fully remote, US-based role.

Comprehensive Benefit Verification

• Conduct thorough phone and portal-based benefit verifications. Once a patient is confirmed as clinically appropriate, you own the VOB from start to finish.
• Determine the details automated checks miss — medical vs. pharmacy routing, code-level coverage, exact deductible/OOP status, coinsurance, coordination of benefits, and prior authorization requirements.
• Translate VOB findings into a clear, actionable summary for the practice. No jargon, no ambiguity — the practice should be able to act on your output without follow-up questions.

2. Prior Authorization Management

• Own the full PA lifecycle for Spravato, TMS, and other treatments: initial submission through approval, with proactive re-authorization so there are never gaps in care.
• Select the right submission channel based on payer and treatment type (CoverMyMeds, Availity, payer-specific portals, fax/phone where needed).
• Monitor status actively. Follow up before things get stuck. On denial, identify the cause and coordinate appeals or peer-to-peer requests with the practice.
• Understand what each payer requires and confirm clinical documentation supports medical necessity before submission.

3. Payer Pushback & Problem Ownership

• When a VOB or PA response doesn't add up, you investigate — you don't just document and move on.
• Call payers back with targeted questions. Cross-reference portal data with phone results. Identify whether the issue is a data error, a policy misapplication, or a legitimate coverage limitation.
• Escalate with context: when you bring an issue to the team, you've already done the legwork.

4. Provider Communication

• Write clear, concise, professional messages to practices. Every benefit summary, PA update, and denial communication should be something a provider can act on without a follow-up call.
• Be the calm, organized voice when a payer outcome is confusing or frustrating. Your follow-through and communication quality are what make a practice feel they're in the best possible hands.

5. Self-Management & Technology

• Manage your own queue. Flag expiring authorizations before they expire. Raise blockers promptly and specifically — don't sit on problems.
• Pick up new platforms quickly and independently. All internal tools are proprietary — you won't have used them before, and that's expected. What we need is the confidence and resourcefulness to learn them.

• 2+ years of hands-on experience in benefit verification and prior authorization (not just claims or cash posting)
• Strong command of VOB vocabulary and mechanics: deductibles, coinsurance, OOP maximums, medical vs. pharmacy routing, PBMs, coordination of benefits
• End-to-end PA lifecycle experience: submission, status monitoring, denial management, appeals
• Experience with major payer portals (Availity, Navinet, Optum, or payer-specific) and pharmacy PA platforms (CoverMyMeds or comparable)
• Clear, professional written English — you can write a provider-facing message that needs zero edits
• Demonstrated ability to learn new technology independently
• US-based, remote-eligible

• Behavioral health, psychiatry, or mental health billing background
• Spravato and/or TMS BV/PA experience
• Experience communicating directly with clinicians or practice administrators
• Familiarity with AI tools (Claude, Gemini) in a daily workflow
• Pylon or comparable ticketing platform experience
• Candid Health experience
• A/R Follow-Up experience