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)
  • Ensuring submissions are organized and meeting payer requirements

Submit appeals/reconsiderations through payer-designated channels

• • Validate successful receipt/acceptance
  • Rapidly correct/resubmit when submissions are rejected or incomplete

Manage an appeal work queue with strict deadline discipline

• • Tracking due dates, statuses, required follow-ups and outcomes
  • Preventing missed appeal windows
  • Ensuring timely outcomes

Communicating proactively with stakeholders

• • Clarifying documentation needs
  • Coordinate next actions
  • Provide clear status updates throughout the appeal lifecycle

Document all actions in an audit-ready manner

• • Ensuring complete traceability for internal review and write-off governance when applicable

Escalating complex or repeat issues

• • Pushing for payer clarification/supervisor review when appropriate
  • Routing patterns of denials to the correct internal owners

Coordinate and support Peer-to-Peer (P2P) reviews

• • Helping to drive scheduling within required timeframes
  • Capturing payer rationale from P2P interactions
  • Preparing appeal documentation in parallel to avoid delays if P2P is upheld

Perform quality reporting, audits, and trend analysis

• • Producing insights that support continuous improvement and denial prevention

Contribute to workflow improvements and standardization

• • Updating templates/checklists
  • Supporting training enablement
  • Helping implement improved tracking/automation practices that strengthen compliance and reimbursement performance

Qualifications:

• Minimum 3 years’ experience in a revenue cycle role managing authorizations and appeals
• Commercial insurance and Medicaid payor experience
• Experience with Texas Medicaid and MCOs preferred
• Competency with private duty nursing and homecare services
• Bachelor's degree preferred
• Ability to evaluate authorization denials, complete appeal packets, and manage complexity with payor protocol and procedure
• Ability to work independently and be detail-oriented ensuring full management of the process
• Strong communication and analytical skills
• Strong Excel skills

What We Offer:

• A supportive and collaborative work environment.
• Opportunities for professional growth and development.
• Comprehensive benefits package, including health, dental, and vision insurance.
• A chance to make a meaningful impact in the lives of children and families.

Classification: Exempt
Reports to:  Manager, Revenue Cycle
Salary Range: $55,000.00 to $70,000.00/year
Location: Hybrid in Mount Laurel, NJ
Apply by: 4/3/2026

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.

*Restrictions Apply