Authorization Appeals Analyst

Job description

Care Options for Kids is hiring an Analyst of Authorization Appeal Management in our Revenue Cycle Management department. Care Options for Kids connects leading pediatric specialists with families to provide best-in-class pediatric nursing, therapy, 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. Key Responsibilities: Evaluate authorization denials/partial determinations for appealability by: - Reviewing case details, payer policy, medical necessity rationale, and claim/authorization data - Determining the most appropriate next steps Assemble complete, defensible appeal packets: - Gathering required evidence (authorization history, eligibility/benefits support, clinical documentation/records and relevant claim details) - E...