Billing/Operations Administration

ABOUT HOPE DISCOVERY ABA SERVICES

Hope Discovery ABA Services is dedicated to supporting the social, intellectual, behavioral, and verbal growth for children with Autism Spectrum Disorders, Asperger’s Syndrome, and Pervasive Developmental Disorder (PDD-NOS). Our approach integrates comprehensive assessments, tailored treatment plans, and parent training with the evidence-based methods of Applied Behavior Analysis in full or part-time center and home program settings.

JOB SUMMARY

The Billing/Operations Administration is responsible for performing key financial and administrative functions at Hope Discovery, including the full cycle billing, payroll processing, client intake, and authorizations, and systems data administration. This role ensures accuracy and compliance across billing and claims activities, including claim submission, payment posting, denial resolution, client invoicing, and account reconciliation, while also processing payroll in accordance with company policies and maintaining organized, audit-ready records. The position requires strong attention to detail, analytical thinking, technical proficiency, and clear communication to support clients, employees and operations. The Billing/Operations Administration collaborates with administrative technicians and clinical staff to resolve discrepancies, streamline workflows, and ensure all processes comply with HIPAA regulations, payer rules, and organizational policies and procedures. The role also requires independent problem-solving and contributes to process improvement initiatives to enhance efficiency and accuracy.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Below is an inclusive but not exhaustive list of knowledge, skills, and abilities required for effective performance in this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

BILLING AND CLAIMS PROCESSING

Responsible for the full billing cycle process, including claim submission, payment posting, denial management, reimbursement recovery, and collection.

• Collaborate with Administrative Lead and Clinical Team to resolve CentralReach appointments converted incorrectly (start/end time, overlapping, duplicate appts, 97155/97153 alignment) unconverted appointments, documentation or coding discrepancies impacting billing
• Prepare and submit clean claims promptly through CentralReach and/or upload and transmit EDI/837P files through payer portals/clearinghouses ensuring all required documentation (notes, supporting documents) is included
• Monitor claim submission status and ensure compliance with payer regulations, ABA billing guidelines, and timely filing limits
• Retrieve and review EOBs/ERAs through payer portals (Availity, Prism, PCE Care Management etc.)
• Reconcile EOBs/ERAs, QuickBooks payments, paper check etc. in CentralReach
• Identify payment variances, underpayments, incorrect adjustments, and resolve discrepancies directly with payers
• Investigate, correct, and resubmit claim rejections and denials within required deadlines
• Track and report root-cause analysis on denials (modifier errors, expired authorizations, coding issues, missing documentation, etc.) to contribute to workflow improvements to increase clean claim rates and reimbursement outcomes
• Follow up with payers on status of unpaid claims, outstanding balances, secondary claims etc.
• Create detailed client invoices in CentralReach for deductibles, copays, coinsurance, and non-covered services
• Generate corresponding invoices through QuickBooks ensuring the amount matches CentralReach records
• Reconcile client accounts in CentralReach in alignment with payments processed through QuickBooks, ensuring accurate account balances across both systems
• Communicate professionally with clients regarding account balance and payment options
• Educate families on insurance benefits/coverage and financial responsibilities
• Maintain organized, accurate, audit-ready billing and financial records within CentralReach
• Maintain payer fee schedules CPT codes and payer-specific modifiers to ensure accurate billing and prevent rejections
• Ensure billing practices comply with CMH policies and payer/commercial insurance rules and regulatory requirements
• Stay current on payer policy updates, coding changes, audits, CMH and Payer fee schedules
• Confirm insurance eligibility, benefits, deductibles, coordination of benefits (COB) and authorizations through payer portals (Availity, Prism, PCE Care Management etc.)
• Set up and maintain client’s payers in CentralReach, ensuring all necessary billing information, payer rules, and authorization requirements are accurately recorded
• Protect client confidentiality and maintain compliance with HIPAA standards at all times
• Perform other billing duties as assigned

PAYROLL PROCESSING

Responsible for processing bi-monthly payroll for all employees by calculating hours worked from CentralReach, entering payroll data into QuickBooks, and completing payroll audits.

• Gather, review and verify payroll data from CentralReach, including regular hours, premium hours, overtime, PTO, and other payroll applicable pay codes
• Conduct audits to ensure accuracy of hours, pay rates, deductions, holiday and paid time off aligned with company policies
• Enter payroll data accurately into QuickBooks, calculate and process payroll adjustments, including retroactive pay, benefit deductions, etc.
• Process approved out-of-cycle payrolls including off-cycle corrections, missed payments, and urgency-based adjustments
• Maintain accurate payroll records and ensure confidentiality of all employee payroll information
• Serves as a point of contact for payroll-related inquiries from employees
• Prepare and distribute payroll and paid time off reports as needed
• Assist with audits and compliance reviews as needed
• Identify opportunities to improve payroll processes, efficiency, and accuracy
• Track and report weekly Billable Hours and Full Time Hours, New Hire Bonus Tracking Hours
• Perform other payroll-related duties as assigned

NEW CLIENT INTAKE & INITIAL AUTHORIZATION

Verify and confirm insurance benefits for ABA services, including coverage, deductibles, copays, out-of-pocket maximums, and pre-authorization requirements, while maintaining accurate and up-to-date client information in CentralReach, including new client data entry, updates, and overall data integrity.

• Access payer portals, call the provider number on the back of the client’s insurance card, or contact third-party administrators to confirm authorization requirements, submission processes, and billing procedures
• Determine/confirm who to bill (payer or third-party policy administrator), clarify policy-specific rules and approval from leadership to proceed with third-party policy administrator coverage
• Submit initial authorization requests for assessments and treatment services, ensuring all clinical documentation, CPT codes, and units meet payer requirements
• Track and monitor pending authorizations and approvals, ensuring requests are completed within payer-specified timeframe
• Communicate with payers to expedite approvals when necessary
• Independently troubleshoot and resolve authorization-related issues, including discrepancies, missing documentation, or unclear payer instruction
• Collaborate with clinical staff to ensure treatment plans, progress notes, and other required documentation support authorization requests
• Notify clinical staff promptly of authorization approvals, denials, or additional documentation requests
• Set up new clients in CentralReach, ensuring all necessary client and authorization information are accurately recorded
• Maintain accurate client profile, changes, updates in CentralReach
• Educate families authorization process
• Support process improvement initiatives to streamline intake and authorization workflows
• Perform other related duties as assigned

OPERATIONS ADMINISTRATION

• Perform monthly insurance verifications on all active clients through CHAMPS and Payer Portals
• Complete monthly training/certification audits to ensure employees meets and maintains payer credentialing requirements
• Track and report weekly billable hours and FT/PT employee hours
• Assist in new hire onboarding administration by ensuring onboarding paperwork is completed and required training certifications for credentialing are received
• Perform other related administration duties as assigned

KNOWLEDGE/SKILLS/ABILITIES

Below is an inclusive but not exhaustive list of knowledge, skills, and abilities required for effective performance in this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Billing & Claims

• Comprehensive understanding of the full ABA revenue cycle, including claim submission, payment posting, denial management, reimbursement recovery, and collections
• Strong knowledge of ABA billing guidelines, payer rules, CPT codes, modifiers, and authorization requirements
• Skilled in preparing clean claims, reviewing EOBs/ERAs, analyzing variances, and resolving denials and rejections
• Ability to interpret payer policies, follow timely filing rules, and maintain audit-ready billing records
• Proficient in communicating financial responsibilities, explaining insurance coverage, and supporting families through billing processes

Systems & Software Proficiency

• Advanced experience using CentralReach for scheduling, billing, documentation review, and client account maintenance
• Proficient in QuickBooks for payment posting, invoice creation, and payroll processing.
• Skilled in navigating payer portals (e.g., Availity, Prism, PCE Care Management, CHAMPS) for eligibility, benefits, claims status, and authorization management
• Ability to reconcile financial data across multiple systems with accuracy and attention to detail

Payroll Administration

• Strong understanding of payroll processes including timekeeping verification, pay codes, overtime rules, deductions, and PTO management
• Skilled in completing payroll audits, processing adjustments, off-cycle payments, and ensuring compliance with company policies
• Ability to maintain strict confidentiality and manage sensitive payroll information
• Capable of identifying process improvements to increase payroll efficiency and accuracy

Authorization & Intake

• Knowledge of ABA authorization workflows, including assessment and treatment authorizations, unit management, and documentation requirements
• Ability to interpret benefit details such as coverage, deductibles, copays, out-of-pocket maximums, and third-party administrator policies
• Skilled in gathering, submitting, and tracking authorization requests while troubleshooting discrepancies with payers
• Strong collaboration skills with clinical teams to ensure documentation supports authorization needs

Analytical & Problem-Solving Skills

• Ability to research, investigate, and resolve discrepancies related to billing, payments, authorizations, and claims
• Strong root-cause analysis skills to identify trends, reduce denials, and improve clean claim rates
• Capable of analyzing payer feedback, policy changes, and documentation requirements to optimize workflows

Communication & Interpersonal Skills

• Professional, clear, and supportive communication with clients, staff, payers, and internal teams
• Ability to explain complex billing or insurance concepts in a way families easily understand
• Strong collaboration with administrative, clinical, and leadership teams to support accurate billing and efficient operations

Organizational & Administrative Skills

• Highly detail-oriented with strong time-management skills
• Ability to maintain organized, accurate, and audit-ready financial and payer documentation
• Skilled in managing multiple priorities, deadlines, and high-volume workflows
• Ability to deliver consistent results that support key performance metrics

PHYSICAL REQUIREMENTS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential function of the job. While performing the duties of this job, the employee is required to:

• Work up to 40 hours a week, 52 weeks a year
• Ability to sit or stand for extended periods while performing computer-based tasks
• Frequent use of hands and fingers to operate a computer, keyboard, and other office equipment
• Ability to communicate clearly in person, via phone, and virtually with clients, staff, and payers
• Occasionally lift or move office supplies, files, or equipment up to 25 pounds
• Visual and auditory ability to review documents, monitor data, and interact effectively with others.
• Ability to see and respond to dangerous situation
• Ability to recall important and commonly used information
• Speak and hear sufficiently to communicate effectively by phone or in person at normal volumes
• Vision must be adequate to read correspondence, computer screen, forms, etc.

WORKING CONDITIONS

• The majority of work is performed in an office environment
• The noise level is usually moderate
• Air quality is good, and temperature may not be controlled

EXPERIENCE

• Required: Minimum of 3-4 years of experience in billing, payroll, administrative operations, or related fields
• Preferred: Experience with ABA or healthcare billing, claims processing, and insurance verification
• Preferred: Proficiency with electronic health record (EHR) systems, preferably CentralReach, and accounting software such as QuickBooks
• Required: Experience managing sensitive payroll, financial, and client data with accuracy and confidentiality.

EDUCATION

• Required: High School Diploma or Equivalent
• Preferred: Associate’s or bachelor’s degree in healthcare administration, accounting, finance, or related field

PRE-EMPLOYMENT REQUIREMENTS

• Pass a Criminal Background Check

BENEFITS OF WORKING WITH HOPE DISCOVERY

• Competitive compensation based upon experience
• Access to health, dental, and vision insurance, SimpleIRA
• PTO, Paid Sick Leave, and Paid holidays

WORKING HOURS

• M – F: 7AM-5PM Schedule TBD based on operational needs
• Occasional adjustments to work schedule may be required to meet critical deadlines or support operational needs
• Location: In-Person- Zeeland Center

Job Type: Full-time

Pay: $20.00 - $23.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k) matching
• Dental insurance
• Health insurance
• Health savings account
• Paid time off
• Referral program
• Retirement plan

Work Location: In person

Salary : $20 - $23