Senior Authorization & Revenue Cycle Specialist (Hybrid)

Care Options for Kids; Delray Beach (FL); Hybrid; USD 45,000 - 55,000; Full time

Benefits offered by this job

Health, dental, and vision insurance

Generous paid time off

401K

Job summary

Care Options For Kids is seeking a Senior Authorizations Specialist to join its revenue cycle team. You will own complex pediatric in-home authorization cases, verify Medicaid benefits, and submit requests through payer portals, phone, or fax.

The role requires 3+ years in healthcare revenue cycle, Florida/Nevada Medicaid experience, and strong EMR and payer portal skills. This hybrid/remote position offers a collaborative environment and growth opportunities.

Qualifications

• Minimum 3 years of experience in healthcare revenue cycle management, with a focus on billing, A/R, or authorizations.
• Experience with private duty nursing authorizations and Florida Medicaid is a plus.
• Advanced proficiency with EMR systems, payer portals, and Microsoft Office tools.

Responsibilities

• Obtain prior authorizations and pre-certifications for in-home nursing services for a dedicated caseload of pediatric clients.
• Verify insurance benefits, coverage limitations, and authorization requirements for Medicaid, managed Medicaid, commercial and federal plans.
• Submit complete and accurate authorization requests through payer portals, phone, or fax.
• Track authorization status and follow up with payers to ensure timely approvals.
• Request, negotiate and complete single case agreements and letter agreements.
• Communicate authorization determinations, requirements, and delays to providers, scheduling teams, and patients.
• Review clinical documentation to ensure it meets payer medical necessity criteria.
• Identify and elevate authorization denials or delays for appeal or peer-to-peer review.
• Maintain accurate records of authorization activity in company EMR systems.
• Track authorization-related denial trends and escalation recurring payer issues.
• Stay current on payer policies, authorization rules, state and federal regulations, and out-of-network reimbursement rules.
• Support denial prevention initiatives and revenue cycle performance improvement efforts.

Skills

Revenue cycle

Authorizations

Microsoft Office

EMR systems

Problem solving

Education

High school diploma or GED

Associate or bachelor’s degree preferred

Tools

EMR systems

Payer portals

Microsoft Office

Job description

Care Options For Kids is seeking a Senior Authorizations Specialist to join its revenue cycle team. You will own complex pediatric in-home authorization cases, verify Medicaid benefits, and submit requests through payer portals, phone, or fax.

The role requires 3+ years in healthcare revenue cycle, Florida/Nevada Medicaid experience, and strong EMR and payer portal skills. This hybrid/remote position offers a collaborative environment and growth opportunities.