ABA Billing Specialist
Our Company
SpringHealth Behavioral Health and Integrated Care
Overview
Join a team where your expertise directly drives financial accuracy and operational excellence. At SpringHealth Behavioral Health & Integrated Care, we are a clinically led organization committed to delivering high-quality, person-centered care—and our billing team plays a critical role in sustaining that mission.
We are seeking an experienced ABA Billing Specialist who thrives in a fast-paced, detail-driven environment and takes pride in getting it right the first time. In this role, you will:
- Serve as a key owner of ABA billing accuracy across commercial payers and Medicaid
- Act as a quality gatekeeper for claims, ensuring clean submissions and minimized denials
- Analyze billing trends, identify errors, and proactively drive corrective actions
- Partner cross-functionally with clinical, operations, and finance teams to resolve issues and improve processes
- Support strong gross collection performance and protect overall revenue integrity
- Monitor and manage denials, collections, and reporting with a high level of accountability
- Communicate insights clearly to leadership and influence process improvements
This role is ideal for someone who is:
- Highly detail-oriented and analytical, with a strong sense of ownership
- Experienced in ABA billing and confident navigating payer requirements
- Comfortable working independently while driving cross-functional collaboration
- Passionate about continuous improvement and operational excellence
This is more than a billing role—it’s an opportunity to make a measurable impact on financial performance while supporting the delivery of life-changing clinical services.
Responsibilities
Key Responsibilities Quality 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,)
- 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.
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 leaders 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
- 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 leaders, managers, and stakeholders.
- Provide concise feedback on:
- What is incorrect
- Why is it 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.
Qualifications
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., 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
- Timely identification and correction of billing issues
- Clear, actionable communication with team leads
- Consistent adherence to compliance and quality standards
