Medical Direct jobs

Job Title: Senior ABA Billing Expert / Revenue Cycle Specialist
Working Hours: M-F 9:00 AM to 5:00 PM EST
Salary Range: $1,500-$2,500 (final offer depends on the client based on your skills and experience)

About the Company

Provides in-home Applied Behavior Analysis (ABA) therapy services for children diagnosed with autism across Indiana and New Jersey.

We are seeking a seasoned, hands-on ABA Billing Expert with comprehensive end-to-end revenue cycle management experience in Applied Behavior Analysis (ABA). This is a high-impact, independent role for a professional who can fully own our billing operations, maximize collections, and resolve complex claim issues from day one with no training required.

Key Responsibilities
End-to-End ABA Claims & Revenue Cycle

• Submit clean primary, secondary, and tertiary ABA claims to commercial payers and Medicaid.
• Audit and monitor claims daily through clearinghouses and payer portals to ensure immediate clean-claim rates.
• Aggressively pursue unpaid, underpaid, rejected, or denied claims through routine follow-ups, corrected claims, and formal clinical appeals.
• Post ERA/EOB payments, balance client accounts, and verify accurate fee schedule rates.
• Apply deep operational knowledge of ABA CPT codes, including 97151, 97152, 97153, 97154, 97155, 97156, 97157, and 97158.

VOB & Authorization Management

• Execute complete, start-to-finish ABA-specific Verifications of Benefits (VOBs), confirming deductibles, copays, out-of-pocket maximums, CPT code restrictions, hour limits, and telehealth guidelines.
• Submit and track initial authorizations and reauthorizations, ensuring alignment with diagnostic reports, BCBA treatment plans, and assessments.
• Maintain a proactive tracking system to renew authorizations prior to expiration and prevent service interruptions.

Systems & Operational Ownership

• Work seamlessly within industry-standard ABA practice management software (advanced experience with CentralReach and/or Rethink required).
• Collaborate with internal operations to ensure BCBA/RBT scheduling, session logs, and supervisory hours match billing rules and authorization constraints.
• Identify recurring payer trends, root-cause rejection patterns, and process bottlenecks to continuously improve internal RCM workflows.

Candidate Requirements

• Direct ABA Experience Required: A minimum of 3–5 years of dedicated, direct ABA billing and claims management experience. Generic medical billing or general healthcare experience alone is strictly insufficient.
• Zero-Training Expectation: Must be able to step into the role and independently manage end-to-end billing, VOBs, authorization tracking, and denial workflows on day one.
• Payer Mastery: Demonstrated success managing both commercial payers (Aetna, BCBS, Optum, Cigna, Humana, etc.) and state Medicaid programs.
• Technical Proficiency: Deep expertise using ABA platforms (CentralReach/Rethink), clearinghouses (Availity, Waystar, Trizetto), and payer portals.
• Proactive Drive: High level of autonomy, excellent organization, and an aggressive follow-through strategy with insurance reps to resolve unpaid claims.

Pay: Php93,000.00 - Php156,000.00 per month

Application Question(s):

• Which U.S. states do you have direct, hands-on experience managing ABA billing and operations in? For each state, please specify whether your experience covers Commercial payers, state Medicaid/MCOs, or both.

Work Location: Remote