ABA Services Billing Manager (In Person 11565)

Role Overview

The Billing Manager will be responsible for the overall strategy, implementation, and management of the company's revenue cycle process. A primary initial focus will be leading the transition from a third-party billing service to a fully operational, in-house billing department. This role requires deep expertise in ABA/Behavioral Health billing, strong leadership skills, and a proven track record of optimizing revenue cycle management (RCM) processes, ensuring compliance, and maximizing reimbursement.

Key Responsibilities

1. Transition Management & Department Buildout (Initial Focus)

• Strategic Planning: Develop and execute a comprehensive project plan for the seamless and timely transition of all billing functions from the third-party vendor to the internal team.

• System Implementation: Oversee the selection, implementation, and optimization of the new electronic health record (EHR) and/or billing management software. (Rethink is the primary EMR with a billing module coming in 2026 and will be considered)

• Process Design: Design, document, and implement all standard operating procedures (SOPs) for the full revenue cycle, including authorization management, claims submission, payment posting, denial management, and patient collections.

• Team Building: Recruit, hire, train, and mentor the new internal billing team

2. Revenue Cycle Management (RCM) & Operations

• Authorization Management: Ensure a robust, proactive system is in place for obtaining and tracking all necessary ABA prior authorizations and ongoing re-authorizations with the Revenue Cycle Specialist/Authorizations team. Tracking expirations, units/hours, renewals and making sure services match authorizations.

• Claims Processing: Oversee the timely and accurate submission of all electronic and paper claims to commercial, state, and private payers (e.g., Medicaid, Commercial, self-funded plans). This includes scrubbing, corrections, appeals, tracking and management of the denials.

• Payer Relations: Act as the primary point of contact for all payer relations, including credentialing, contract review, fee schedule negotiation, and issue resolution.

• Accounts Receivable (A/R) Management: Manage and monitor A/R aging reports, focusing on minimizing days in A/R and aggressively pursuing denial appeals and underpayments.

• Payment & Adjustment Posting: Supervise the accurate posting and reconciliation of payments and contractual adjustments. This includes payer portals and EFT/ERA management.

• Credentialing and Upkeep: Oversee new contracts, enrolling providers, groups and locations in addition to CAQH and other upkeep.

• Eligibility: Oversee staff who run eligibility, communicating with parents regarding deductibles, copays and other patient responsibilities.

3. Compliance, Reporting & Analysis

• Compliance: Ensure all billing practices are 100% compliant with HIPAA, state and federal regulations, and payer-specific requirements, especially concerning CPT codes and modifiers specific to ABA services.

• Reporting: Generate and present regular RCM performance reports to executive leadership, including key performance indicators (KPIs) such as clean claim rate, denial rate, collection rate, and A/R aging.

• Auditing: Conduct regular internal audits of coding, documentation, and billing practices to identify areas for improvement and maintain data integrity.

• Growth: As the business needs change, other areas of responsibility will be discussed and delegated by upper management as needed.

• Analytics: Analysis of certain KPIs and upkeep.

Required Qualifications

• Experience: Minimum of 5 years of experience in medical billing, with at least 3 years specifically in ABA/Behavioral Health billing.

• Management: Minimum of 2 years of experience in a supervisory or management role overseeing a billing team.

• Payer Expertise: Extensive, proven knowledge of the payer landscape for ABA services, including authorization requirements, coding (CPT, ICD-10), and claims submission for major commercial and governmental payers.

• Software Proficiency: Demonstrated proficiency with a major ABA-specific EHR/billing software (e.g., CentralReach, Thread, WebABA, etc.).

• Education: Bachelor’s degree in Healthcare Administration, Finance, Business, or a related field preferred.

• Certification (Preferred): Certified Professional Biller (CPB) or similar credential.

Competencies & Skills

• Project Management: Excellent organizational skills with the ability to manage complex, time-sensitive projects (the in-house transition).

• Analytical Skills: High proficiency in data analysis, reporting, and utilizing billing metrics to drive process improvements.

• Leadership: Strong ability to lead, motivate, and develop a high-performing team.

• Communication: Exceptional verbal and written communication skills for interacting with payers, executive staff, and clinical teams.