Key Responsibilities:
- Submit accurate and timely claims for ABA services to private insurance, Medicaid, and other payers
- Verify insurance eligibility and benefits for new and existing clients
- Track and follow up on unpaid or denied claims; initiate appeals as needed
- Manage authorizations, re-authorizations, and documentation requirements for ongoing services
- Reconcile payments, post EOBs, and generate client invoices as needed
- Maintain compliance with HIPAA, payer guidelines, and ABA-specific billing codes (e.g., CPT 97151, 97153, 97155)
- Collaborate with BCBAs, administrative staff, and families to resolve billing issues and ensure smooth revenue cycle operations
Requirements:
- 2+ years of medical billing experience, with a strong focus on ABA or behavioral health services
- Proficiency in billing software and clearinghouses (e.g., CentralReach, Office Ally, Kareo, SimplePractice)
- In-depth knowledge of ABA billing codes, modifiers, and payer-specific requirements
- Strong organizational and follow-up skills
- Familiarity with Medicaid and commercial insurance billing processes
- High attention to detail and ability to manage multiple accounts
Preferred Qualifications:
- Experience with CentralReach or similar ABA-specific EMR platforms
- Understanding of insurance credentialing and contracting (a plus)
- Bilingual (English/Spanish) is a bonus but not required
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