Revenue Cycle Specialist

Job Title: Revenue Cycle Specialist (ABA Therapy)
Department: Revenue Cycle
Reports To: VP of RCM
FLSA Status: Exempt

Position Summary

The Revenue Cycle Specialist is responsible for managing the end-to-end billing process for ABA therapy services, ensuring accurate credentialing, claims submission, payment posting, and efficient accounts receivable (A/R) follow-up. This role plays a critical part in maintaining the financial integrity of the organization by ensuring timely reimbursement, minimizing denials, and supporting families with accurate billing communication — all in strict alignment with payer regulations and HIPAA compliance.

Key Responsibilities

Insurance Eligibility, Credentialing & Intake

• Complete patient intake, insurance eligibility, and benefits verification (VOB) prior to service delivery.

• Manage and maintain credentialing and payer enrollment for clinicians and organization.

• Manage referrals and obtain authorizations for ABA services as required by payers.

Claims Processing & Billing Operations

• Collect and verify insurance information monthly to maintain billing accuracy.

• Reconcile daily ABA sessions to ensure all are converted and linked to correct authorizations.

• Collaborate with the clinical team to ensure progress notes are converted and compliant for billing.

• Prepare, code (ABA billing codes, CPT, ICD-10), and transmit claims daily to clearinghouse/payers.

• Submit secondary and tertiary claims when applicable.

• Manage monthly billing cycles and generate patient statements.

Collections, A/R & Reconciliation

• Proactively follow up on outstanding/pending claims within a few days of submission.

• Research, track, and resolve claim rejections/denials within 24 hours.

• Post payments accurately and reconcile all payments and adjustments.

• Perform A/R follow-up, appeals, and monitor aging reports to ensure healthy cash flow.

• Manage patient billing inquiries professionally and establish payment terms when needed.

Compliance, Reporting & Data Integrity

• Maintain HIPAA compliance and confidentiality of all financial/patient records.

• Retain and organize billing records in accordance with company policy and legal requirements.

• Generate and deliver online revenue/cycle reports as directed by management.

• Maintain current knowledge of payer policies, billing regulations, and ABA billing practices.

Qualifications

Required:

• Minimum 2 years of experience in medical billing, revenue cycle, or insurance claims.

• Strong knowledge of CPT, ICD-10, and ABA billing/coding guidelines.

• Experience with payer portals, clearinghouses, and EMR/billing platforms.

• High accuracy and attention to detail in claims, posting, and documentation.

Preferred:

• Prior experience in ABA therapy billing or behavioral health setting.

• Knowledge of Medicaid, commercial payers, and multi-payer billing environments.

Skills & Competencies

• Strong understanding of healthcare billing and A/R processes.

• Excellent follow-through and ability to work independently with urgency.

• Professional communication with both payers and patients.

• Strong organizational skills, time management, and confidentiality awareness.

• Ability to collaborate cross-functionally with clinical and operations teams.

Pay Range

$60,000 - $70,000 (salary will be based on qualifications and experience)