Pediatric Revenue Cycle Lead & Authorization

Care Options for Kids; Philadelphia (Philadelphia County); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Health, dental, and vision insurance

Generous paid time off

401K

Collaborative work environment

Growth opportunities

Job summary

Care Options for Kids is seeking a Lead, Revenue Cycle - Authorization Services to oversee authorizations for in-home pediatric services. You will manage a small team, handle prior authorizations, pre-certifications, and continued stays, and ensure adherence to payer guidelines and regulatory requirements.

The role emphasizes expertise in PA payer requirements, EMR literacy, and using data analytics to reduce delays and improve reimbursement outcomes.

Qualifications

• Experience acting as SME for authorization services and payers.

Responsibilities

• Lead a small team of Authorization Specialists.
• Obtain prior authorizations and pre-certifications for in-home pediatric services.
• Navigate PA payer requirements including MCOs and Medicare Advantage.
• Monitor status and drive timely resolution of requests.
• Manage agreements and out-of-network authorizations when needed.
• Conduct quality audits and mentor staff on guidelines and policies.
• Analyze trends and performance data to improve outcomes.
• Maintain documentation in EMR and revenue cycle systems.
• Leverage data analytics and automation to boost efficiency.
• Stay updated on policies and regulations; support leadership.

Skills

Authorization management

Payer requirements (PA Medicaid, MCOs)

EMR systems

Payer portals

Data analytics

Team leadership

Regulatory compliance

Tools

EMR systems

Payer portals

Microsoft Office

Reporting platforms

Workflow tools

Job description

Care Options for Kids is seeking a Lead, Revenue Cycle - Authorization Services to oversee authorizations for in-home pediatric services. You will manage a small team, handle prior authorizations, pre-certifications, and continued stays, and ensure adherence to payer guidelines and regulatory requirements.

The role emphasizes expertise in PA payer requirements, EMR literacy, and using data analytics to reduce delays and improve reimbursement outcomes.