Billing Specialist

Job Description

REQUIREMENTS

• 3+ years of hands-on ABA billing experience — this is non-negotiable. General medical billing experience without ABA-specific knowledge won’t translate well to this role.
• Deep working knowledge of ABA CPT codes (97151, 97153, 97154, 97155, 97156, 97157, 97158) and the modifier requirements that go with them (HO, HM, HN, GT, etc.)
• Strong understanding of ABA authorization workflows — initial auths, concurrent reviews, renewals, and how auth errors translate into denials
• Strong experience with state Medicaid ABA billing — Colorado and/or Maryland strongly preferred
• Familiarity with major commercial payers’ ABA policies and auth requirements (CareFirst, Cigna, Aetna, UnitedHealthcare/Optum)
• Demonstrated denial management experience — you can read a denial, understand the root cause, and execute the right appeal
• Comfortable working independently in a remote, high-trust environment
• Strong written and verbal communication; able to clearly explain billing and auth issues to non-billing stakeholders

RESPONSIBILITIES

• Submit clean, accurate claims for ABA services across Medicaid and commercial payers (Colorado Medicaid, Maryland Medicaid, CareFirst BCBS, Cigna, Aetna, and others)
• Partner closely with our authorizations department to ensure every claim is backed by a valid, accurate authorization — including correct CPT codes, unit allocations, date ranges, and rendering providers
• Review authorization submissions and renewals before they go out to payers, flagging issues that could create downstream billing problems
• Reconcile authorized units against billed and delivered units; alert clinical and auth teams to overages, underutilization, or upcoming expirations before they become revenue leaks
• Investigate, appeal, and resolve claim denials and underpayments; identify root causes (auth-related, credentialing, coding, documentation) and implement process fixes to prevent recurrence
• Manage aged AR aggressively — follow up on outstanding claims, escalate with payers when needed, and keep days-in-AR within target
• Post payments from ERAs and EOBs; reconcile against expected reimbursement and flag variances
• Verify benefits and eligibility; coordinate with clinical and admin teams to prevent intake- and auth-related denials
• Monitor and report on billing KPIs: clean claim rate, first-pass resolution rate, denial rate by payer/code, days in AR, collection rate, and auth-related denial trends
• Stay current on payer policy changes, fee schedule updates, and ABA-specific billing rules (CPT code changes, modifier requirements, telehealth POS rules, authorization requirements by payer, etc.)
• Partner with leadership to continuously improve billing and authorization workflows, documentation requirements, and operational handoffs between clinical, auth, and billing teams

Are you interested in this position?

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