Lead, Revenue Cycle - Authorization Services

Care Options for Kids connects leading pediatric specialists with families to provide best-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.

• 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.

• 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.

• A supportive and collaborative work environment.
• Opportunity to Join a Rapidly Growing, Fast-Paced Organization!
• Comprehensive benefits package, including health, dental, and vision…