ABA Services Billing Manager (In Person 11565)

Job Description

Job Description

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.