Senior Authorization Specialist - Remote Pediatric Care

Care Options for Kids; Fellowship (NJ); Hybrid; USD 45,000 - 55,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

401K

Job summary

Care Options For Kids is seeking a Senior Associate, Authorization Services to join our revenue cycle team as a subject matter expert and escalation point. This role demands advanced knowledge of revenue cycle operations, independent problem solving, and a proactive, solution-oriented mindset.

You will own complex authorization cases, obtain pre-certifications for in-home nursing, verify benefits, submit requests, track status, and communicate determinations to providers and patients while

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.
• Nevada and/or Florida Medicaid experience.
• Advanced proficiency with EMR systems, payer portals, and Microsoft Office.

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 elevate 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 management

Authorization experience

Problem-solving

Communication skills

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 Associate, Authorization Services to join our revenue cycle team as a subject matter expert and escalation point. This role demands advanced knowledge of revenue cycle operations, independent problem solving, and a proactive, solution-oriented mindset.

You will own complex authorization cases, obtain pre-certifications for in-home nursing, verify benefits, submit requests, track status, and communicate determinations to providers and patients while