PPS Utilization Review - TMS Care Manager

Discovery Behavioral Health • Austin, TX

2d

About The Position

At Anew Era TMS & Psychiatry, our team of dedicated psychiatrists, psychologists, psychiatric nurse practitioners, and licensed therapists offers customized, comprehensive care designed around your needs. We provide a range of options, including in-person and online therapy, medication management, and advanced interventional treatments like transcranial magnetic stimulation (TMS) therapy, ketamine, and esketamine—all delivered in a safe and compassionate environment. With access to most commercial insurance plans, we make quality mental health care more accessible, helping you uncover the right path to wellness.

Requirements

• Minimum of 1 year in medical authorizations, care coordination, or behavioral health administration.
• Familiarity with TMS therapy protocols and behavioral health diagnoses.
• Strong knowledge of insurance verification, prior authorization, and payer-specific requirements (Medicare and commercial insurers).
• Proficiency in EHR systems and insurance portals.
• Excellent organizational, communication, and problem-solving abilities.

Responsibilities

• Prepare and submit prior authorization requests for TMS services, including both initial and continuation of treatment.
• Review and compile medical necessity documentation, such as psychiatric evaluations, medication trials, and symptom assessments.
• Communicate with insurance companies to verify benefits, follow up on pending authorizations, and resolve denials or delays.
• Maintain accurate and up-to-date records in the EHR and internal tracking systems for authorizations, approvals, peer reviews, and appeals.
• Collaborate with providers, TMS technicians, and billing staff to ensure clinical documentation and billing accuracy.
• Educate patients on the authorization process, expected timelines, and financial responsibilities.
• Stay current with payer-specific policies, documentation requirements, and TMS-related CPT codes.
• Schedule cortical mappings once insurance approval is on file.
• Manage and update cortical mapping and authorization reports.
• Confirm that all patients are clinically cleared and meet medical necessity criteria for TMS treatment.
• Support medical providers with scheduling and address questions related to TMS patient care and workflows.
• Check the status of all pending authorizations at least every 48 hours.
• Coordinate and complete peer reviews as needed to support medical necessity.
• Other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed