Senior Manager, Pediatric Revenue Cycle & Authorizations

Care Options for Kids; Pennsylvania; Vor Ort; USD 90.000 - 120.000; Vollzeit

Benefits dieser Stelle

Health benefits

Paid time off

401K

Career growth

Meaningful impact

Zusammenfassung

Care Options For Kids is seeking a Lead, Revenue Cycle - Authorization Services in Pennsylvania to oversee authorization workflows. You will lead a small team, obtain prior authorizations, and ensure compliance with PA payer guidelines, including Medicaid MCOs and Medicare Advantage, while maintaining accurate EMR documentation.

The role emphasizes process improvement, data-driven decisions, and collaboration with cross-functional leaders to minimize delays and optimize reimbursement.

Qualifikationen

• Extensive experience managing authorizations for Pennsylvania payers, including Medicaid MCOs, Medicare Advantage plans, commercial carriers, and out-of-network arrangements.
• Proven success leading authorization workflows in healthcare, home health, pediatric, or revenue cycle environments.
• Strong technical proficiency with EMR systems, payer portals, reporting tools, and related technology.

Aufgaben

• Serve as SME for authorization services, overseeing a payer group and leading a small team of Authorization Specialists.
• Obtain prior authorizations, pre-certifications, and continued stay approvals with active caseload.
• Demonstrate expertise in PA payer requirements, including Medicaid MCOs, Medicare Advantage, and commercial insurers.
• Monitor authorization status, follow up with payers, and drive timely resolution to prevent delays.
• Conduct quality audits and provide training and feedback to ensure compliance with policies and regulations.
• Maintain documentation in EMR systems ensuring data integrity and audit readiness.

Kenntnisse

Leadership

Coaching

Team management

Quality audits

Tools

EMR systems

Payer portals

Microsoft Office

Reporting platforms

Workflow tools

Jobbeschreibung

Care Options For Kids is seeking a Lead, Revenue Cycle - Authorization Services in Pennsylvania to oversee authorization workflows. You will lead a small team, obtain prior authorizations, and ensure compliance with PA payer guidelines, including Medicaid MCOs and Medicare Advantage, while maintaining accurate EMR documentation.

The role emphasizes process improvement, data-driven decisions, and collaboration with cross-functional leaders to minimize delays and optimize reimbursement.