RCM Benefits Verification and Prior Authorization Specialist

About Osmind

Osmind is a company specializing in technology, services, and data exclusively for psychiatry. Mental health disorders, a leading cause of death globally, are linked to reduced life expectancy. Thankfully, recent advances in psychiatric treatments — including ketamine, Spravato, and neuromodulation — along with a collective effort by clinicians, patients, and researchers, are bridging the gap between innovation and practical care.

We support over 1,000 independent psychiatry practices across the U.S., enabling them to deliver high-quality care, grow their operations, and contribute to research through our customized electronic health record (EHR) system, software tools, and managed services. Our providers treat some of the most complex psychiatric cases nationally.

Osmind is a San Francisco-based public benefit corporation, backed by prominent investors such as DFJ Growth, Future Ventures, General Catalyst, and Y Combinator.

Role Overview

The BV & PA Specialist is critical in our Revenue Cycle Management (RCM) team, responsible for ensuring accuracy and timeliness in benefits verification and prior authorization. These functions are essential for patient financial estimates, submitting claims, avoiding denials, and maintaining smooth cash flow. Errors in this area can cause downstream issues.

This role serves as the initial point of contact for practices engaging with Osmind’s RCM services. Managing benefit verifications and prior authorizations diligently sets the standard and assures practices that they are working with top specialists in interventional psychiatry. It is a high-touch role, requiring you to maintain an excellent professional tone.

You'll manage the entire lifecycle of benefit verification and prior authorization for treatments like Spravato and Transcranial Magnetic Stimulation (TMS): conducting phone and portal verifications, submitting and tracking prior authorization requests, and communicating clearly with practices to enable confident patient scheduling.

This position is entirely remote and open to candidates based in the United States.

Responsibilities

• Perform comprehensive benefit verification using phone calls and online portals, managing the verification of benefits (VOB) from initiation to completion once clinical appropriateness is confirmed.
• Clarify details often missed by automated systems, such as distinguishing between medical and pharmacy benefits, code-level coverage, deductibles, out-of-pocket costs, coinsurance, coordination of benefits, and prior authorization requirements.
• Summarize VOB results in clear, jargon-free explanations that practices can use immediately without needing additional clarification.
• Manage the full prior authorization lifecycle for Spravato, TMS, and other interventional treatments, from initial submission through approval, including proactive re-authorizations to prevent treatment interruptions.
• Choose the appropriate submission channel depending on payer and treatment type, including platforms like CoverMyMeds, Availity, payer-specific portals, or fax/phone where necessary.
• Actively monitor the status of prior authorizations, proactively following up before delays occur. When denials happen, investigate causes and coordinate appeals or peer-to-peer reviews with the practice.
• Understand payer-specific requirements and verify that the submitted clinical documentation supports medical necessity before submission.
• Investigate discrepancies in VOB or PA responses instead of merely recording them, including following up with payers to clarify issues, cross-checking portal and phone data, and distinguishing between errors, policy misapplications, or valid coverage limitations.
• Provide context when escalating issues to team members, having already conducted thorough preliminary research.
• Communicate professionally and clearly in writing with practices, ensuring every correspondence on benefits, prior authorization, or denials can be acted upon without additional calls.
• Maintain composure and clarity when explaining confusing or challenging payer outcomes, reassuring practices that they are supported by skilled professionals.
• Manage your work queue independently, tracking expiring authorizations to flag renewals in advance and promptly raising any blockers with clear, specific details.
• Learn and adapt quickly to new proprietary internal tools and platforms without prior experience, demonstrating resourcefulness and confidence.

Requirements

• At least two years of direct experience handling benefit verification and prior authorization processes—not just claims processing or cash posting.
• Strong expertise in benefits terminology and mechanics, including deductibles, coinsurance, out-of-pocket limits, differentiating medical vs. pharmacy benefits, pharmacy benefit managers (PBMs), and coordination of benefits.
• Experience managing the complete prior authorization process: submission, monitoring progress, managing denials, and conducting appeals.
• Familiarity with major payer portals such as Availity, Navinet, Optum, or payer-specific systems, and pharmacy prior authorization platforms like CoverMyMeds or equivalents.
• Excellent written English communication skills, able to craft provider-facing messages requiring no corrections.
• Proven ability to independently learn and adapt to new technology.
• Must be based in the United States and eligible to work remotely.

Preferred Qualifications

• Experience in behavioral health, psychiatry, or mental health billing.
• Prior benefits verification and prior authorization experience specifically with Spravato and/or TMS treatments.
• Background in communicating directly with clinicians or practice administrators.
• Familiarity with AI tools such as Claude or Gemini in daily workflows.
• Experience with ticketing platforms like Pylon or similar systems.
• Knowledge of Candid Health.
• Accounts receivable (A/R) follow-up experience.

Compensation and Benefits

The annual salary for this position ranges from $60,000 to $65,000 based on experience, with eligible employees offered an equity package. Osmind provides an extensive benefits package including healthcare, dental, vision coverage, generous family leave, flexible spending accounts (FSA/DCFSA), mental health support, a 401(k) plan, and flexible paid time off.

Additional Information

This role is fully based in the United States with minimal travel required. Osmind encourages applicants from a wide range of backgrounds and promotes diversity, equity, and inclusion. Applicants who do not meet every listed qualification are still encouraged to apply, as unique skills and experiences are valued.

AI tools may assist in parts of the hiring process like resume analysis and application review but do not replace human decision-making. Final hiring decisions remain with Osmind’s recruitment team.