Lead, Revenue Cycle - Authorization Services

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 Kidsconnectsleading pediatric specialistswith families to providebest-in-class pediatric therapy, nursing, and school-based services. We seamlessly integrate into children’s lives by bringing individualized care to children where they live, work, and play.

Ourpediatric specialistsare committed to providinghigh-quality pediatricservices that help children and families live their best lives. We empower our community of clinicians to meet children where they are byproviding the support and resourcesnecessary to decrease administrative burdens. This focus allows our clinicians to obtain optimal work-life balance.

Lead, Revenue Cycle - Authorization Services

Key Responsibilities

• Serve as the subject matter expert (SME) for authorization services, overseeing a designated payer group while leading, coaching, and developing a small team of Authorization Specialists.
• Obtain prior authorizations, pre-certifications, and continued stay approvals for in-home healthcare and pediatric services, while maintaining an active caseload of medium to high-complexity accounts.
• Demonstrate advanced expertise in Pennsylvania payer authorization requirements, including Pennsylvania Medicaid Managed Care Organizations (MCOs), Medicare Advantage, commercial insurers, and out-of-network authorization processes.
• Monitor authorization status, proactively follow up with payers, and drive timely resolution of pending requests to prevent delays in care and reimbursement.
• Request, negotiate, and manage single case agreements, letters of agreement, and out-of-network authorization arrangements when appropriate.
• Conduct quality audits and provide ongoing training, mentorship, and performance feedback to ensure team compliance with payer guidelines, company policies, and regulatory requirements.
• Analyze authorization trends, denial patterns, productivity metrics, and payer performance data to identify root causes and implement corrective actions that improve authorization success rates and revenue cycle outcomes.
• Maintain accurate and thorough documentation of authorization activity within EMR systems and other revenue cycle platforms, ensuring data integrity and audit readiness.
• Leverage payer portals, EMR systems, reporting tools, automation technologies, and data analytics to improve workflow efficiency, reduce manual effort, and support operational decision-making. The ideal candidate is highly technology-savvy, embraces new technology solutions, and can effectively identify opportunities for automation and process optimization.
• Stay current on payer policies, authorization requirements, state and federal regulations, reimbursement methodologies, and industry best practices, serving as a resource for the team and leadership.
• Partner with Revenue Cycle, Clinical Operations, Billing, Collections, and Branch Leadership teams to resolve barriers, support denial prevention initiatives, and drive continuous improvement efforts that enhance patient access, financial performance, and operational excellence.

Preferred Specialized Experience

• Extensive experience managing authorizations for Pennsylvania payers, including Medicaid MCOs, Medicare Advantage plans, commercial carriers, and out-of-network reimbursement arrangements.
• Proven success leading authorization workflows in a healthcare, home health, pediatric, or revenue cycle environment.
• Strong technical proficiency with EMR systems, payer portals, Microsoft Office applications, reporting platforms, workflow tools, and technology-enabled process improvement initiatives.

What we Offer:

• A supportive and collaborative work environment.
• Opportunity to Join a Rapidly Growing, Fast-Paced Organization!
• Comprehensive benefits package, including health, dental, and vision insurance.
• Generous Paid Time Off
• 401K
• A chance to make a meaningful impact in the lives of children and families.

Care Options For Kidsis an equal opportunity employer. The Equal Employment Opportunity Policy of Care Options For Kids is to provide a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religion, national origin, gender, sexual orientation, age, marital status or disability. Care Options For Kids hires and promotes individuals solely on the basis of their qualifications for the job to be filled. Care Options For Kids believes that associates should be provided with a working environment which enables each associate to be productive and to work to the best of his or her ability. We do not condone or tolerate an atmosphere of intimidation or harassment based on race, color, religion, national origin, gender, sexual orientation, age, marital status or disability. We expect and require the cooperation of all associates in maintaining a discrimination and harassment-free atmosphere.