Benefits Verification/Prior Authorization Specialist

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 and treatments since the first FDA approval in 1954, including 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 Osmind, we serve a network of 1,000+ independent psychiatry practices across the country. 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 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 everything downstream is built on — patient financial estimates, claim submission, denial avoidance, cash flow. When it's wrong, the consequences cascade.

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

You will execute 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 the patient can be scheduled with confidence.

Key Responsibilities

1. Comprehensive Benefit Verification (Spravato & TMS)

• Execution of comprehensive checks. Once the clinical team confirms a patient is appropriate, you assume ownership of the phone- and portal-based verification.
• Complex coverage analysis. Determine details automated checks miss — including whether the drug routes through medical or pharmacy benefits, code-level coverage (J/G/S codes for Spravato; CPT codes for TMS), and exact deductible / out-of-pocket statuses.
• Documentation in the EHR. Document your findings clearly in the Osmind EHR and translate them into a clear, actionable response to the provider.

2. Prior Authorization (PA) Management

• End-to-end ownership. Manage the full PA lifecycle for Spravato and TMS, from initial submission through approval, and stay ahead of re-authorizations so there are never gaps in care.
• Strategy & submission. Based on BV findings, select the correct submission channel — pharmacy PA platforms (CoverMyMeds and similar) or medical payer portals (Availity, Optum, payer-specific) and fax/phone where needed.
• Clinical alignment. Understand what each payer requires and confirm those criteria are present in the practice's documentation before submission. (We use AI tools to assist with parsing clinical notes — the goal is for you to know what needs to be there, not to be a clinician.)
• Follow-up & appeals. Proactively monitor submission status. On denial, identify the cause and coordinate with the practice on appeals or peer-to-peer requests.

3. Spravato withMe Program Management

• Become a confident user of the Spravato withMe portal — we'll train you here. Review portal benefit details, transpose data into the EHR, verify enrollment forms, and resolve enrollment bottlenecks.

4. Provider Communication

• Write clear, concise, professional messages to providers. Every benefit summary, PA update, and denial communication is one a provider can act on without follow-up.
• Be the calm, organized voice. You're often the bridge between a confusing payer outcome and a practice that needs to make a decision. The quality of your writing — and your follow-through — is what makes a provider feel they're working with the best.

5. Internal Communication & Self-Management

• Communicate openly and frequently. When you're blocked, you raise it in the right channel within hours — not days. You don't bottle up problems. You're specific about what you've tried, where you're stuck, and what you need.
• Track your own work. You manage your queue without being chased; you flag expiring authorizations before they expire.

Qualifications & Requirements

• Experience: 2+ years specifically in Benefit Verification and Prior Authorization
• Coverage fluency: You can clearly explain the difference between medical and pharmacy benefits and what a PBM is. If you don't have direct Spravato experience, you can apply that logic quickly and pick up the specifics fast
• Platform experience:
  • Required: CoverMyMeds (or comparable pharmacy PA platform); major payer portals (Availity, Optum, Navinet, or payer-specific)
• Written English: Clear, professional, concise — you can write a provider-facing message that needs zero edits
• AI-native: You use Claude, Gemini, or comparable tools in your daily workflow. You understand prompting basics and that AI can be wrong
• Communication style: Comfortable with open, frequent, direct communication — raising blockers fast, asking clear questions
• Schedule: Able to work 10am–6pm EST from the Philippines

Strong Pluses

• Spravato and/or TMS BV/PA experience — significant differentiator
• Spravato withMe portal experience
• Pylon experience (our ticketing platform)
• Slack experience
• Familiarity with mental health/psychiatry benefits

How to Apply

In your application, please include a short response (1–2 sentences) to the following:

Imagine you just confirmed with a payer that a patient's prior authorization has been denied because the clinical documentation didn't include enough detail on prior failed treatments. Write the message you would send to the practice explaining what happened and what you need from them. Be concise, professional, and to-the-point.

We read these carefully. They tell us how you communicate — which is one of the most important parts of this role.

This is a remote contract role based in the Philippines, working 10am–6pm EST.