Billing and Credentialing Specialist

Job Description

Job Description

We are seeking an ABA Billing & Credentialing Specialist to support our billing and revenue cycle operations. This role will primarily focus on Verification of Benefits (VOB), ABA authorizations, and provider credentialing with commercial insurance plans and Medicaid. The ideal candidate is highly organized, detail-oriented, and proactive. Ideally has experience working with health insurance, payer processes, authorizations, credentialing, or healthcare administration and is comfortable managing multiple deadlines while maintaining accurate documentation and consistent follow-up. 

Location: Queens, NY 
Job Type: Part-time (25 hours per week) 
Work Setting: In-Office 
Compensation: $23-$33 

Responsibilities  

• Verify client insurance eligibility and benefits for ABA services, including coverage limits, deductibles, copays, coinsurance, out-of-pocket maximums, and authorization requirements 

• Obtain, submit, and track initial and ongoing ABA prior authorizations and reauthorizations with commercial insurance plans and Medicaid 

• Monitor authorization periods, approved units, service codes, and expiration dates and proactively initiate renewals to prevent gaps in services 

• Complete and maintain accurate Verification of Benefits documentation and communicate coverage requirements to appropriate internal teams 

• Manage ABA provider credentialing and recredentialing with commercial payers and Medicaid, including initial applications, renewals, revalidations, and roster updates 

• Maintain accurate provider information and credentialing documentation, including licenses, certifications, NPI information, CAQH records, and other required documents 

• Research payer-specific credentialing, enrollment, and authorization requirements and ensure applications and submissions are complete and accurate 

• Follow up with insurance companies and Medicaid plans regarding pending authorizations, credentialing applications, enrollment status, and outstanding documentation 

• Maintain accurate payer, provider, client, and authorization records in internal systems and tracking tools 

• Collaborate with clinical, intake, scheduling, and billing teams to resolve insurance, authorization, credentialing, and coverage issues 

• Maintain detailed records of payer communications, application status, authorization information, follow-up dates, and outstanding action items 

• Handle confidential client and provider information in accordance with HIPAA, payer requirements, and company policies 

Qualifications  

• 2+ years of experience in healthcare billing, insurance verification, prior authorizations, credentialing, provider enrollment, or a related healthcare administrative role preferred 

• Previous experience in the ABA industry strongly preferred, particularly with VOB, authorizations, credentialing, or insurance processes 

• Working knowledge of commercial insurance plans and Medicaid/Medicaid managed care programs 

• Experience submitting and tracking prior authorizations and reauthorizations preferred 

• Experience verifying insurance benefits and interpreting coverage information 

• Experience with provider credentialing, payer enrollment, or recredentialing preferred 

• Familiarity with CAQH, NPI requirements, payer portals, and Medicaid enrollment systems preferred 

• Familiarity with ABA services, CPT codes, billing units, and payer authorization requirements preferred 

• Exceptional attention to detail and ability to maintain accurate records and documentation 

• Strong organization and follow-through, with the ability to manage multiple payers, providers, applications, and deadlines 

• Excellent written and verbal communication skills and ability to communicate professionally with payers, providers, and internal teams 

• Proficiency with Microsoft Office, Excel/Google Sheets, electronic health records, and payer portals; CentralReach experience is a plus 

About us:  

We are a growing ABA organization dedicated to helping individuals with autism and their families build meaningful skills, greater independence, and fulfilling lives. Our administrative and billing teams play an important role in supporting clinical operations and helping ensure families have access to necessary services. 

• Growing ABA organization with opportunities for professional growth 

• Collaborative and supportive team environment 

• Opportunity to develop expertise in ABA insurance, authorizations, VOB, and credentialing 

• Work closely with clinical, operations, and leadership teams 

• Play a critical role in helping ensure clients can access and continue receiving ABA services 

• Opportunities for career growth as the organization expands 

EEO Statement  
We are an Equal Opportunity Employer. We do not discriminate on the basis of race, color, religion, gender, national origin, age, disability, or any other status protected by applicable law. We value and are committed to creating an inclusive environment for all employees.  

Interested in joining our team? Apply today to be considered for the ABA Billing & Credentialing Specialist position.  

 
BALP