The Authorization Specialist is responsible for obtaining prior authorizations and verifying insurance coverage for pediatric patients. This includes therapy, behavioral health, diagnostic procedures, specialist visits, surgeries, injections, infusion therapies, and advanced radiology services (CT, MRI, PET, and Nuclear Medicine). The specialist plays a critical role in ensuring timely access to care, supporting families in navigating the insurance process, and helping minimize financial barriers to treatment.
Responsibilities:
Secure prior authorizations for a variety of pediatric services.
Verify insurance eligibility and benefits prior to service; ensure benefits and authorizations are clearly documented in the patient record.
Gather, verify, and review the necessary clinical documentation from providers, including medical records, progress notes, lab results, treatment plans, and any other require information to ensure requested services meeting payer medical necessity requirements based on CPT codes provided.
Coordinate with clinical and scheduling teams to prevent delays in care caused by pending or denied authorizations.
Participate in clinical huddles and team meetings to discuss challenges, share best practices, and contribute to process improvement initiatives.
Follow-up with payers to obtain timely approvals and resolve issues related to pediatric-specific criteria (e.g., age-based guidelines, developmental appropriateness).
Communicate denied authorizations and next steps to initiate the peer to peer or appeal process, track and manage the outcomes, and escalate any issues.
Refer families to Financial Counseling when patient responsibility amounts are identified and provide clear guidance to support caregiver understanding.
Maintain accurate records of authorization statuses and payer communications in the EHR.
Collaborate with care teams, including case management, to expedite authorizations for urgent services when needed.
Meet departmental standards for productivity, accuracy, and timeliness.
Other information:
Technical Expertise
Knowledge of medical terminology, CPT/ICD-10 codes, and pediatric insurance benefits.
Strong interpersonal communication skills to support families with empathy and clarity.
Ability to navigate multiple systems (EHR, payer portals); Epic experience preferred.
Understanding of medical necessity and documentation standards for pediatric services.
Education and Experience
Education: High school diploma or equivalent required; associate degree or healthcare certification preferred.
Experience: Minimum 1 year in a Clinical, Revenue Cycle, Patient Access or Insurance company role that perform work related to; prior authorization, insurance verification, billing, scheduling, patient service rep, customer service, etc. required.
Pediatric healthcare access roles preferred.
Working with pediatric patients, families, or within a children's hospital preferred.
Familiarity with pediatric insurance policies, including Medicaid, managed care, and commercial plans preferred.
More Than a Job. It’s loving what you do - and why you do it. Akron Children’s Hospital is ranked among the best pediatric hospitals by U.S. News & World Report, but it’s our compassionate approach to treatment that sets us apart. It’s creating special high-fives. Thinking of new ways to spark a smile. Holding hands to offer comfort. And working to get a giggle that brightens a room. The minute you walk into Akron Children’s, you can sense that people here love what they do. From visits with the Doggie Brigade, to the balloons and smiles in the halls, the sights and sounds are all about one thing: the children. We are the largest pediatric healthcare system in Northern Ohio and one of the fastest growing in the country. Akron Children’s has two hospital campuses in Northeast Ohio: one in Akron and the other in Boardman in the Mahoning Valley. With two hospital campuses, regional health centers and more than 50 primary and specialty care locations throughout Ohio, we’re making it easier for today’s busy families - regardless of where they live - to find the high-quality care they need. No matter which of our locations you choose, you’ll see that when you give the most, you get more—...support, rewards and satisfaction. CAREER OPPORTUNITIES: It’s making the most of your days. Our passion is felt every day in the way people care at every level. Whether you are working with children face-to-face, or behind the scenes supporting the care and services we deliver, you impact futures. Visit us and see why it’s more than just a place to work. It’s a family. Apply today at careers.akronchildrens.org.