Job Overview

Our client is seeking an experienced and highly accountable ABA Insurance Verification and Claims Specialist to own the full revenue and authorization lifecycle for an active Applied Behavior Analysis (ABA) therapy organization. This is a high-level, specialized position—not an entry-level clerical role.

The successful candidate must possess deep domain expertise within the behavioral health sector, confidently managing everything from advanced Verification of Benefits (VOB) to complex behavioral health appeals and utilization reviews from day one. You will act as the operational anchor ensuring clinical treatment plans smoothly transition into paid, authorized therapy hours with minimal executive oversight.

Schedule

• Monday – Friday 9:00 AM – 5:00 PM US Eastern Time (EST) (40 hours per week)

Responsibilities

1. Advanced ABA Verification of Benefits (VOB)

• End-to-End Auditing: Complete comprehensive, ABA-specific Verification of Benefits (VOBs) from initial inquiry through final structural documentation.
• Parameter Verification: Accurately verify and log detailed authorization requirements, deductible progress, out-of-pocket maximums, copays, coinsurance, and network benefit tiers.
• ABA-Specific Constraints: Verify strict CPT code coverage, daily/weekly service hour limitations, and telehealth parity rules across both commercial insurance and state Medicaid plans.

2. Utilization Review, Authorizations & Reauthorizations

• Submission Ownership: Independently compile, format, and submit initial authorization and time-sensitive reauthorization packets to insurance payers.
• Clinical Asset Gathering: Review and package complex clinical documentation, including diagnostic reports, individual treatment plans, formal assessments, and BCBA supporting documentation.
• Pipeline Monitoring: Proactively track rolling authorization expiration dates to manage reauthorization timelines, resolving denials and requests for information (RFIs) to prevent service gaps.

3. Specialized Billing & Claims Management

• Revenue Cycle Execution: Submit ABA insurance claims and aggressively investigate unpaid, denied, rejected, or underpaid files across in-network and out-of-network models.
• Appeals Operations: Code and process corrected claims, technical resubmissions, and sophisticated level-1 and level-2 insurance appeals.
• Clearinghouse Mastery: Efficiently navigate diverse payer web portals and centralized medical clearinghouse systems to clear clearinghouse rejections.

4. Clinical Operations Coordination

• Cross-Functional Sync: Collaborate directly with Board Certified Behavior Analysts (BCBAs), Registered Behavior Technicians (RBTs), and clinical staff to align scheduling with active authorization parameters.
• Workflow Optimization: Manage the operational intersection of clinical treatment plans, supervision ratios, authorization cycles, and billing workflows to continuously improve internal cash-flow efficiencies.

Required CPT Code Mastery

Candidates must possess an active, working knowledge of authorization rules, billing combinations, and compliance parameters for the following core ABA codes:

• 97151: Behavior Identification Assessment
• 97153: Adaptive Behavior Treatment by Protocol (Direct Therapy)
• 97155: Type 2 Adaptive Behavior Treatment with Protocol Modification (Supervision)
• 97156: Family Adaptive Behavior Treatment Guidance (Parent Training)

Required Qualifications

• ABA Operational Footprint: Minimum 3+ years of direct, verifiable insurance operations experience specifically working within an ABA therapy organization. General medical billing or generic healthcare administration experience alone is not sufficient.
• Payer Landscape Literacy: Proven success interacting with both commercial health insurers and state-administered Medicaid managers regarding behavioral health mandates.
• Full-Spectrum Autonomy: Demonstrated history independently executing VOBs, utilization reviews, billing cycles, denial tracking, and complex appeals from day one.
• Communication Polish: Exceptional written and verbal English communication skills suited for direct, assertive negotiations with insurance medical directors and clear internal messaging to clinical teams.

Preferred Qualifications (Nice-to-Have)

• Extensive hands-on administrative familiarity with CentralReach or Rethink practice management software.
• Experience balancing ledgers for both in-network and out-of-network behavioral health structures.
• Background in structural process improvement, insurance workflow building, or collection strategy design.

Independent Contractor Perks

• Permanent work from home framework
• Immediate hiring timelines
• Health Insurance Coverage for eligible locations 

Note

Please click the "Apply" button to complete your application, including the assessment questions, technical check, and voice recording. Your hourly pay rate will be established based on your performance in the application process; submissions with all requirements fulfilled will receive priority review.