Lead, Revenue Cycle - Authorization Services

Care Options for Kids connects leading pediatric specialists with families to providebest-in-class pediatric therapy, nursing, and school-based services. We seamlessly integrate into children's lives by bringing individualized care to children where they live, work, and play.

Our pediatric specialists are committed to providing high-quality pediatric services that help children and families live their best lives. We empower our community of clinicians to meet children where they are by providing the support and resources necessary to decrease administrative burdens. This focus allows our clinicians to obtain optimal work-life balance.

Lead, Revenue Cycle - Authorization Services

Key Responsibilities

• Serve as the subject matter expert (SME) for authorization services, overseeing a designated payer group while leading, coaching, and developing a small team of Authorization Specialists.
• Obtain prior authorizations, pre-certifications, and continued stay approvals for in-home healthcare and pediatric services, while maintaining an active caseload of medium to high-complexity accounts.
• Demonstrate advanced expertise in Pennsylvania payer authorization requirements, including Pennsylvania Medicaid Managed Care Organizations (MCOs), Medicare Advantage, commercial insurers, and out-of-network authorization processes.
• Monitor authorization status, proactively follow up with payers, and drive timely resolution of pending requests to prevent delays in care and reimbursement.
• Request, negotiate, and manage single case agreements, letters of agreement, and out-of-network authorization arrangements when appropriate.
• Conduct quality audits and provide ongoing training, mentorship, and performance feedback to ensure team compliance with payer guidelines, company policies, and regulatory requirements.
• Analyze authorization trends, denial patterns, productivity metrics, and payer performance data to identify root causes and implement corrective actions that improve authorization success rates and revenue cycle outcomes.
• Maintain accurate and thorough documentation of authorization activity within EMR systems and other revenue cycle platforms, ensuring data integrity and audit readiness.
• Leverage payer portals, EMR systems, reporting tools, automation technologies, and data analytics to improve workflow efficiency, reduce manual effort, and support operational decision-making. The ideal candidate is highly technology-savvy, embraces new technology solutions, and can effectively identify opportunities for automation and process optimization.
• Stay current on payer policies, authorization requirements, state and federal regulations, reimbursement methodologies, and industry best practices, serving as a resource for the team and leadership.
• Partner with Revenue Cycle, Clinical Operations, Billing, Collections, and Branch Leadership teams to resolve barriers, support denial prevention initiatives, and drive continuous improvement efforts that enhance patient access, financial performance, and operational excellence.

Preferred Specialized Experience

• Extensive experience managing authorizations for Pennsylvania payers, including Medicaid MCOs, Medicare Advantage plans, commercial carriers, and out-of-network reimbursement arrangements.
• Proven success leading authorization workflows in a healthcare, home health, pediatric, or revenue cycle environment.
• Strong technical proficiency with EMR systems, payer portals, Microsoft Office applications, reporting platforms, workflow tools, and technology-enabled process improvement initiatives.

What we Offer:

• A supportive and collaborative work environment.
• Opportunity to Join a Rapidly Growing, Fast-Paced Organization!
• Comprehensive benefits package, including health, dental, and vision insurance.
• Generous Paid Time Off
• 401K
• A chance to make a meaningful impact in the lives of children and families.

If you are the best at what you do, and are ready to work with an innovative, positive and supportive organization, please contact us today.

Care Options For Kids is an equal opportunity employer. The Equal Employment Opportunity Policy of Care Options For Kids is to provide a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religion, national origin, gender, sexual orientation, age, marital status or disability. Care Options For Kids hires and promotes individuals solely on the basis of their qualifications for the job to be filled. Care Options For Kids believes that associates should be provided with a working environment which enables each associate to be productive and to work to the best of his or her ability. We do not condone or tolerate an atmosphere of intimidation or harassment based on race, color, religion, national origin, gender, sexual orientation, age, marital status or disability. We expect and require the cooperation of all associates in maintaining a discrimination and harassment-free atmosphere.

RDADMIN