Senior Pediatric Authorization Specialist (Remote)

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

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

Job summary

Care Options For Kids is seeking a Senior Associate, Authorization Services to serve as a subject matter expert in the revenue cycle. You will own complex authorization cases, coordinate with payers, and ensure timely prior authorizations for pediatric in-home nursing services.

Ideal candidates have at least 3 years in healthcare revenue cycle, experience with Medicaid and payer portals, and strong communication skills.

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.
• Identify and escalate authorization denials or delays for appeal or peer-to-peer review.
• Maintain accurate records of authorization activity in EMR systems.
• Review clinical documentation to ensure it meets payer medical necessity criteria.

Skills

Revenue cycle management

EMR systems

Payer portals

Microsoft Office

Communication skills

Education

High school diploma or GED

Associate or bachelor’s degree preferred

Job description

Care Options For Kids is seeking a Senior Associate, Authorization Services to serve as a subject matter expert in the revenue cycle. You will own complex authorization cases, coordinate with payers, and ensure timely prior authorizations for pediatric in-home nursing services.

Ideal candidates have at least 3 years in healthcare revenue cycle, experience with Medicaid and payer portals, and strong communication skills.