ABA Billing Specialis and Data Quality Assurance Analyst
Arohana Support
RemoteRemoteFrom $50,000 a yearFull Time
Job Description
*Job Overview*
The *ABA Quality Assurance & Billing Specialist *is a senior, detail-oriented role responsible for ensuring accuracy, compliance, and financial performance across ABA billing operations. This individual must have deep, hands-on expertise in ABA billing across U.S. commercial payers and Medicaid , and will serve as a quality gatekeeper for claims, reporting, collections, and denial management.
This role oversees the *quality and productivity of multiple billing teams*, proactively identifies errors and trends, and communicates clearly with team leads to drive corrective action. The specialist is accountable for protecting revenue, maintaining clean claims, and supporting strong Gross Collection Rates (GCR) for all assigned clients. When needed, this role will directly submit claims to ensure timely and accurate billing.
This position requires exceptional attention to detail, strong analytical skills, clear communication, and the ability to work independently while influencing cross-functional teams.
*Key ResponsibilitiesQuality Assurance & Oversight*
* Perform ongoing quality audits of claims prior to and after submission to ensure accuracy, compliance, and payer-specific requirements are met.
* Review claims for correct:
* CPT codes and modifiers (e.g., 97151, 97153, 97155, 97156, 97158, H0031, etc.)
* Provider credentials and supervision requirements
* Units, rates, authorizations, and service locations
* Diagnosis codes and payer-specific billing rules
* Identify billing trends, recurring errors, and systemic issues impacting claims, payments, or denials.
* Ensure all billing processes align with ABA best practices, payer contracts, and state Medicaid guidelines.
*Billing Production & Performance Management*
* Oversee and monitor billing production across assigned teams to ensure:
* Claims are submitted timely and accurately
* Daily, weekly, and monthly billing targets are met
* Track and evaluate key revenue cycle metrics, including:
* Gross Collection Rate (GCR)
* Days in A/R
* First-pass claim acceptance rates
* Denial rates and resolution timelines
* Hold teams accountable to performance standards and escalate concerns when benchmarks are not met.
*Denials, Collections & Follow-Ups*
* Review and analyze denials across commercial and Medicaid payers.
* Identify root causes of denials and provide clear, actionable guidance to team leads on how to prevent recurrence.
* Support and oversee collections and follow-up efforts to ensure underpaid or denied claims are resolved appropriately.
* Ensure appeals are accurate, complete, and submitted within payer deadlines.
*Claims Submission & Direct Billing Support*
* Submit claims directly when needed to support clients, address backlog, or resolve urgent billing issues.
* Ensure claims are scrubbed and validated prior to submission to maximize first-pass acceptance.
* Assist with payer re-submissions, corrected claims, and appeal filings as required.
*Communication & Cross-Team Collaboration*
* Communicate findings clearly and professionally to team leads, managers, and stakeholders.
* Provide concise feedback on:
* What is incorrect
* Why it is incorrect
* What must be fixed
* How to prevent future errors
* Collaborate with credentialing, authorizations, and clinical documentation teams to resolve upstream issues impacting billing.
* Serve as a subject-matter expert (SME) for ABA billing questions across payers and states.
*Process Improvement & Compliance*
* Contribute to the development and refinement of billing workflows, SOPs, and QA checklists.
* Stay current on:
* ABA billing regulations
* Commercial payer policy changes
* Medicaid updates across multiple states
* Proactively recommend process improvements to increase efficiency, accuracy, and collections.
*Required Qualifications*
* *5+ years of hands-on ABA billing experience*, including both commercial payers and Medicaid.
* In-depth knowledge of:
* ABA CPT codes and modifiers
* Authorization requirements
* Supervision and rendering provider rules
* State-specific Medicaid billing nuances
* Proven experience working with denials, appeals, collections, and payer follow-ups.
* Strong understanding of revenue cycle metrics, including GCR and A/R management.
* High level of proficiency in billing systems and clearinghouses (e.g., CentralReach, WebABA, Rethink, Availity, Waystar, etc.).
Core Competencies & Skills
* *Exceptional attention to detail* — consistently catches errors others miss.
* *Highly self-motivated* — able to manage workload independently and prioritize effectively.
* *Clear and confident communicator* — able to give direct, professional feedback to team leads and stakeholders.
* *Analytical mindset* — able to identify trends, root causes, and data-driven solutions.
* *High accountability* — takes ownership of outcomes and revenue integrity.
* *Process-driven* — values structure, documentation, and consistency.
* *Collaborative but firm* — able to influence teams while maintaining high standards.
Performance Expectations
Success in this role is measured by:
* Reduced claim error rates and denials
* Improved first-pass acceptance rates
* Strong or improving GCR for assigned clients
* Timely identification and correction of billing issues
* Clear, actionable communication with team leads
* Consistent adherence to compliance and quality standards
Pay: From $50,000.00 per year
Benefits:
* Paid time off
Work Location: Remote
The *ABA Quality Assurance & Billing Specialist *is a senior, detail-oriented role responsible for ensuring accuracy, compliance, and financial performance across ABA billing operations. This individual must have deep, hands-on expertise in ABA billing across U.S. commercial payers and Medicaid , and will serve as a quality gatekeeper for claims, reporting, collections, and denial management.
This role oversees the *quality and productivity of multiple billing teams*, proactively identifies errors and trends, and communicates clearly with team leads to drive corrective action. The specialist is accountable for protecting revenue, maintaining clean claims, and supporting strong Gross Collection Rates (GCR) for all assigned clients. When needed, this role will directly submit claims to ensure timely and accurate billing.
This position requires exceptional attention to detail, strong analytical skills, clear communication, and the ability to work independently while influencing cross-functional teams.
*Key ResponsibilitiesQuality Assurance & Oversight*
* Perform ongoing quality audits of claims prior to and after submission to ensure accuracy, compliance, and payer-specific requirements are met.
* Review claims for correct:
* CPT codes and modifiers (e.g., 97151, 97153, 97155, 97156, 97158, H0031, etc.)
* Provider credentials and supervision requirements
* Units, rates, authorizations, and service locations
* Diagnosis codes and payer-specific billing rules
* Identify billing trends, recurring errors, and systemic issues impacting claims, payments, or denials.
* Ensure all billing processes align with ABA best practices, payer contracts, and state Medicaid guidelines.
*Billing Production & Performance Management*
* Oversee and monitor billing production across assigned teams to ensure:
* Claims are submitted timely and accurately
* Daily, weekly, and monthly billing targets are met
* Track and evaluate key revenue cycle metrics, including:
* Gross Collection Rate (GCR)
* Days in A/R
* First-pass claim acceptance rates
* Denial rates and resolution timelines
* Hold teams accountable to performance standards and escalate concerns when benchmarks are not met.
*Denials, Collections & Follow-Ups*
* Review and analyze denials across commercial and Medicaid payers.
* Identify root causes of denials and provide clear, actionable guidance to team leads on how to prevent recurrence.
* Support and oversee collections and follow-up efforts to ensure underpaid or denied claims are resolved appropriately.
* Ensure appeals are accurate, complete, and submitted within payer deadlines.
*Claims Submission & Direct Billing Support*
* Submit claims directly when needed to support clients, address backlog, or resolve urgent billing issues.
* Ensure claims are scrubbed and validated prior to submission to maximize first-pass acceptance.
* Assist with payer re-submissions, corrected claims, and appeal filings as required.
*Communication & Cross-Team Collaboration*
* Communicate findings clearly and professionally to team leads, managers, and stakeholders.
* Provide concise feedback on:
* What is incorrect
* Why it is incorrect
* What must be fixed
* How to prevent future errors
* Collaborate with credentialing, authorizations, and clinical documentation teams to resolve upstream issues impacting billing.
* Serve as a subject-matter expert (SME) for ABA billing questions across payers and states.
*Process Improvement & Compliance*
* Contribute to the development and refinement of billing workflows, SOPs, and QA checklists.
* Stay current on:
* ABA billing regulations
* Commercial payer policy changes
* Medicaid updates across multiple states
* Proactively recommend process improvements to increase efficiency, accuracy, and collections.
*Required Qualifications*
* *5+ years of hands-on ABA billing experience*, including both commercial payers and Medicaid.
* In-depth knowledge of:
* ABA CPT codes and modifiers
* Authorization requirements
* Supervision and rendering provider rules
* State-specific Medicaid billing nuances
* Proven experience working with denials, appeals, collections, and payer follow-ups.
* Strong understanding of revenue cycle metrics, including GCR and A/R management.
* High level of proficiency in billing systems and clearinghouses (e.g., CentralReach, WebABA, Rethink, Availity, Waystar, etc.).
Core Competencies & Skills
* *Exceptional attention to detail* — consistently catches errors others miss.
* *Highly self-motivated* — able to manage workload independently and prioritize effectively.
* *Clear and confident communicator* — able to give direct, professional feedback to team leads and stakeholders.
* *Analytical mindset* — able to identify trends, root causes, and data-driven solutions.
* *High accountability* — takes ownership of outcomes and revenue integrity.
* *Process-driven* — values structure, documentation, and consistency.
* *Collaborative but firm* — able to influence teams while maintaining high standards.
Performance Expectations
Success in this role is measured by:
* Reduced claim error rates and denials
* Improved first-pass acceptance rates
* Strong or improving GCR for assigned clients
* Timely identification and correction of billing issues
* Clear, actionable communication with team leads
* Consistent adherence to compliance and quality standards
Pay: From $50,000.00 per year
Benefits:
* Paid time off
Work Location: Remote