Position Summary
Oversee daily revenue cycle operations for ABA services, ensuring accurate billing, timely claim submission, payment posting, denial management, and compliance with payer and regulatory requirements. Lead and support the billing team, collaborating with clinical, authorization, and finance staff to resolve issues and maximize reimbursement.
Key Responsibilities
- Supervise all ABA revenue cycle activities: charge review, claims, payment posting, denials, appeals, AR follow-up.
- Ensure claims are submitted, followed up, and resolved within payer deadlines.
- Monitor revenue cycle metrics (AR, denials, clean claim rates, collections) and report results.
- Maintain up-to-date knowledge of ABA CPT codes, payer policies, and billing rules.
- Identify and address trends impacting reimbursement and cash flow.
- Collaborate with clinical and authorization teams to resolve claim and authorization issues.
- Supervise, train, and develop billing staff, ensuring high productivity and accuracy.
- Ensure compliance with federal/state regulations, payer requirements, and internal policies.
Qualifications
- High school diploma required; associate or bachelor’s degree in healthcare, business, or related field preferred.
- 3–5 years’ healthcare billing/revenue cycle experience (ABA or behavioral health strongly preferred); supervisory experience preferred.
- Strong knowledge of ABA CPT codes (97151–97156), payer rules, denials, AR, EOBs/ERAs, and clearinghouses.
- Analytical, detail-oriented, and skilled in problem-solving and communication.
- Proficient with Excel and billing/revenue cycle software.
Success Measures
- Timely, accurate claim submission and payment posting
- Reduction in denials and aged AR
- Improved clean claim rates and cash collections
- High staff productivity and accountability
- Effective cross-team communication
