Lead Pediatric Revenue Cycle & Authorization

Care Options for Kids; Pittsburgh (Allegheny County); On-site; USD 95,000 - 125,000; Full time

Benefits offered by this job

Health, dental & vision insurance

Generous Paid Time Off

401K

Job summary

Care Options for Kids, a leading provider of pediatric therapy and in-home services, is seeking a Lead, Revenue Cycle - Authorization Services. You will oversee a payer group and a small team of Authorization Specialists, ensuring timely authorizations and optimal reimbursement.

Responsibilities include managing Pennsylvania payer requirements, driving process improvements, auditing performance, and leveraging EMR systems and portals to enhance efficiency.

Qualifications

• Extensive experience managing authorizations for Pennsylvania payers, including Medicaid MCOs and Medicare Advantage.
• Proven ability to lead, coach and develop Authorization Specialists teams.
• Strong technical proficiency with EMR systems, payer portals, and reporting tools.

Responsibilities

• Serve as SME for authorization services, overseeing a payer group and a small team of Authorization Specialists.
• Obtain prior authorizations, pre-certifications, and continued stay approvals for in-home pediatric services.
• Monitor status, follow up with payers and drive timely resolutions to prevent delays.
• Negotiate and manage single case agreements and out-of-network authorizations when needed.
• Conduct audits, training, and feedback to ensure compliance with guidelines and regulations.
• Analyze trends and payer performance data to improve authorization success and revenue cycle outcomes.
• Maintain documentation in EMR and revenue cycle platforms for audit readiness.
• Leverage payer portals and analytics to improve workflow and automate processes.

Skills

Authorization management

Payer policy expertise

EMR proficiency

Team leadership

Process improvement

Tools

EMR systems

Payer portals

Microsoft Office

Reporting tools

Job description

Care Options for Kids, a leading provider of pediatric therapy and in-home services, is seeking a Lead, Revenue Cycle - Authorization Services. You will oversee a payer group and a small team of Authorization Specialists, ensuring timely authorizations and optimal reimbursement.

Responsibilities include managing Pennsylvania payer requirements, driving process improvements, auditing performance, and leveraging EMR systems and portals to enhance efficiency.