Senior Authorization Specialist - Remote Pediatrics

Care Options for Kids; Las Vegas (NV); Hybrid; USD 45,000 - 55,000; Full time

Benefits offered by this job

Health, dental, and vision insurance

Job summary

Care Options For Kids is seeking a Senior Associate in Authorization Services to serve as a subject matter expert within our revenue cycle team. You will own complex authorization cases, navigate payer portals, and coordinate with providers to obtain timely approvals for pediatric in-home nursing services.

The role emphasizes independent problem-solving, continuous improvement, and the ability to manage multiple priorities in a remote-friendly, fast-paced environment.

Qualifications

• Minimum 3 years of experience in healthcare revenue cycle management, with focus on billing, A/R, or authorizations.
• Experience with private duty nursing authorizations.
• Nevada and/or Florida Medicaid experience.
• Demonstrated success in resolving complex RCM issues independently.
• 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 EMR systems.
• Stay current on payer policies, authorization rules, state and federal regulations, and out-of-network reimbursement rules.

Skills

Revenue cycle management

Payer policies

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 in Authorization Services to serve as a subject matter expert within our revenue cycle team. You will own complex authorization cases, navigate payer portals, and coordinate with providers to obtain timely approvals for pediatric in-home nursing services.

The role emphasizes independent problem-solving, continuous improvement, and the ability to manage multiple priorities in a remote-friendly, fast-paced environment.