ABA Billing & Credentialing Specialist

Position Summary

The ABA Billing & Credentialing Specialist is responsible for supporting the organization’s revenue cycle, insurance billing, provider credentialing, and related administrative functions. This position ensures services are billed accurately and timely, payments are properly processed, outstanding claims are followed up on, and providers maintain appropriate credentialing and enrollment with insurance payers.

Billing & Revenue Cycle Responsibilities

• Review services and supporting documentation for billing accuracy, completeness, and compliance.

• Prepare and submit insurance claims accurately and within required payer timelines.

• Verify CPT codes, units, modifiers, service locations, rendering providers, and authorization information prior to claim submission.

• Update and maintain client authorizations in Theralytics

• Monitor insurance authorizations and authorized units as they relate to billing and claims.

• Submit prior authorization requests to payers in a timely manner

• Review and work rejected, denied, and unpaid claims in a timely manner.

• Correct and resubmit claims as appropriate.

• Prepare and submit reconsiderations, corrected claims, and appeals when necessary.

• Follow up with insurance companies regarding outstanding, delayed, or unpaid claims.

• Maintain and actively work Accounts Receivable (A/R) aging to support timely reimbursement.

• Review EOBs, ERAs/835 files, payer correspondence, and other remittance information.

• Post insurance payments, contractual adjustments, and patient responsibility accurately.

• Reconcile payments against submitted claims and expected reimbursement.

• Assist with weekly billing and payment posting

• Identify payer underpayments and follow up for appropriate reimbursement.

• Research and resolve unapplied, unidentified, or incorrectly posted payments.

• Identify recurring billing, denial, or reimbursement issues and communicate trends and concerns to management.

• Coordinate with clinical, scheduling, intake, and administrative staff to resolve billing discrepancies.

• Assist with month-end billing, payment reconciliation, and revenue reporting.

• Monitor and follow up on outstanding client copays and other patient-responsibility balances.

• Maintain accurate billing records and documentation in accordance with payer, company, and applicable compliance requirements.

• Perform additional billing, administrative, and related duties based on organizational needs.

Credentialing & Provider Enrollment

• Manage initial credentialing and recredentialing of applicable clinical providers.

• Complete and submit provider enrollment applications.

• Maintain provider information in CAQH and applicable payer portals.

• Track credentialing applications through completion.

• Follow up with insurance companies regarding pending applications.

• Maintain credentialing trackers, effective dates, and recredentialing deadlines.

• Collect and maintain required licenses, certifications, NPI information, liability insurance, and other credentialing documents.

• Monitor expiration dates for required provider credentials.

• Complete provider additions, terminations, demographic changes, and roster updates.

• Assist with NPI, EFT, and ERA enrollment as needed.

• Coordinate credentialing for newly hired providers.

• Communicate credentialing delays or barriers that may affect staffing or billing.

Insurance Contracting Support

• Maintain payer contracts, fee schedules, amendments, and reimbursement information.

• Track contracted rates by payer and CPT code.

• Compare reimbursements against contracted rates.

• Assist with payer rate-increase requests and contract updates.

• Maintain payer contact and escalation information.

• Assist with adding providers, service locations, and programs to payer contracts.

• Support management with insurance contracting projects as needed.

• General Administrative & Operational Support

• Maintain organized electronic billing, credentialing, and payer records.

• Assist with insurance-related audits and documentation requests.

• Communicate with insurance representatives, staff, clients, and families as appropriate.

• Participate in billing, administrative, and operations meetings.

• Prepare reports or trackers requested by management.

• Assist with data entry, record maintenance, document preparation, and administrative projects.

• Cross-train on other administrative functions to provide coverage when needed.

• Assist other departments during periods of increased workload or staff absence.

• Support process improvement projects related to billing, credentialing, intake, insurance, or administrative operations.

• Perform additional administrative, billing, credentialing, intake, or operational responsibilities based on the needs of the organization.

• Perform other duties and special projects as assigned by management based on business and operational needs.

Compliance

• Maintain confidentiality of client, employee, and provider information.

• Follow HIPAA requirements and organizational privacy and security policies.

• Follow applicable payer billing, documentation, and credentialing requirements.

• Maintain accurate records and documentation to support internal and external audits.

Preferred Qualifications

• Medical, behavioral health, or ABA billing experience preferred.

• Experience with insurance credentialing and provider enrollment preferred.

• Familiarity with ABA CPT codes, including 97151, 97153, 97155, and 97156.

• Experience reviewing EOBs/ERAs and resolving claim denials.

• Knowledge of Accounts Receivable and insurance follow-up.

• Familiarity with CAQH, NPPES/NPI, payer portals, EFT/ERA, and electronic claims.

• Strong organizational skills and attention to detail.

• Ability to prioritize responsibilities based on changing operational needs.

• Ability to manage multiple deadlines and projects independently.

• Strong written and verbal communication skills.

• Willingness to cross-train and take on additional responsibilities as the organization's needs evolve.

Pay: $20.00 - $28.00 per hour

Expected hours: 30.0 – 40.0 per week

Benefits:

• 401(k)

• Dental insurance

• Health insurance

• Paid time off

• Parental leave

• Referral program

• Vision insurance

Application Question(s):

• How many years of experience do you have in Medical, Behavioral Health, or ABA billing?

Language:

• Spanish (Preferred)

Work Location: In person