Insurance Authorizations Director - KidsCare Home Health

Pursue your passion and fulfill your purpose at KidsCare! KidsCare Home Health is a multi-award-winning organization who was most recently recognized as a 2023 U.S. Top Workplace. As an award-winning organization, we are looking for dedicated professionals who will embrace the KidsCare core values.

This position is an in office position in Dallas,TX with a set hybrid schedule after an initial training period.  At KidsCare we desire to work with individuals who embody the values of the organization which together create our C.A.R.E. culture. In return we offer a full benefits package to include health, dental, and vision insurance, paid time off, 401K with employer matching, and tuition reimbursement. 

The Authorizations Director will be responsible for overseeing the daily functions and providing strategic leadership of the Authorizations Department. This role ensures the department processes and workflow support location’s specific authorization policies and procedures to achieve optimal operational and patient outcomes.

Essential Duties and Responsibilities

•  Oversee all functions of the Authorizations Department, including Medicaid, Commercial Insurance, and Private Pay
• Analyze authorizations trends and changes within insurance plans and present the relevant data to executive management
• Proactively notify appropriate departments of changes to payer requirements that may affect our ability to continue services or receive reimbursement.
• Routinely monitor departmental workflow status to ensure timely completion of departmental tasks and proactively intervene when workflow bottlenecks arise
• Audit current processes and implement best practices, standards, and procedures in all functions of the department
• Create an open and collaborative relationship with other department leaders to aide in the identification of hindrances to workflow and resolution of payer issues
• Implement departmental procedural changes based on billing denial trends and recommendations from Revenue Cycle Director
• Review provider releases routinely to identify changes to authorization requirements and maintain strong relationships with current and future payers
• Develop and maintain process, procedure, and policy documentation
• Maintain a strong working knowledge of all systems.
• Provide leadership, mentorship, and supervision to others through motivation, direction, review, and feedback
• Champion continuous improvement through educating, training, and developing the Authorizations Department team members.
• Serve as the key point of contact for leadership regarding authorization processes, procedures, and payer requirements.
• Comply with all safety policies, practices, and procedures.  Report unsafe activity to your Manager, VP of Human Resources, VP of Compliance and/or Chief Operating Officer. 
• Perform other duties as assigned

Other Qualifications and Skills

• Analytical skills, mathematical and number skills, critical thinking. 
• Proficiency in Microsoft Office Suite (Excel, Outlook, Word). 
• In-depth understanding of the healthcare industry, payer relations, and compliance regulations and standards. 
• Strong interpersonal and communication skills. 
• Strong data analytics abilities to include systems development and process improvement. 
• Ability to oversee multiple priorities while remaining focused on the details. 

Education and Work Experience Requirements

• Bachelor’s degree in healthcare administration, business, or related field
• Five (5) or more years of healthcare administration experience
• Three (3) to Five (5) years of management experience.
• Medical billing/revenue cycle experience preferred.

Physical Demands/Working Environment

 Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  

• While performing the duties of this job, the employee is regularly required to, stand, sit; talk, hear, and use hands and fingers to operate a computer and telephone keyboard. 
• Ability to sit at a computer for an extended period. 
• Light to moderate physical activity and lifting is required. 
• Specific vision abilities required by this job include close vision requirements. 
• Moderate noise (i.e., business office with computers, phone, and printers, light traffic). 

About KidsCare

Established in 2003, we are a pediatric home health agency serving children with special needs across the country. Our focus is on nursing, speech, physical, and occupational therapy as well as providing case management for children up to 18 years of age.  Founded upon the principle that patient care/therapy is most effective when it is one-on-one, set in a familiar environment and includes family member and caregiver involvement, the organization has grown from its original roots in Dallas Texas to a multi-state operation.  Regardless of this growth, however, our original commitment of providing quality health care to every child and family serviced as never changed. If you are looking to be a part of a company whose culture is rooted in the C.A.R.E of others, please review the opportunity below and be sure to visit our website at  https://kidscarehomehealth.com/careers-overview/ for a full listing of our open positions.