Quality Specialist Board Certified Behavior Analyst

Job Summary: The Quality Specialist (BCBA) is responsible for ensuring the clinical accuracy, completeness, and compliance of Applied Behavior Analysis (ABA) services delivered across the organization. This role conducts systematic reviews of treatment plans and session documentation to uphold the highest standards of clinical quality, ethical practice, payer compliance, and client outcomes. This is a non-exempt position.

Qualifications/Educational Requirements:

1. Active Board Certified Behavior Analyst (BCBA) certification in good standing with the BACB.
2. Active state licensure (or eligibility) in applicable jurisdiction(s) as required.
3. Minimum 3 years of clinical experience in an ABA setting delivering or supervising services.
4. Solid understanding of ABA CPT codes, particularly 97153 and 97155, and associated documentation standards.
5. Familiarity with payer requirements (Medicaid, commercial insurance) related to ABA service authorization and billing.
6. Strong analytical, written communication, and organizational skills.

Responsibilities/essential functions: The person in this position must be able to perform the following essential job functions with or without reasonable accommodations.

Treatment Plan Review

1. Conduct thorough reviews of individualized ABA treatment plans for clinical accuracy, medical necessity, and alignment with assessment findings (e.g., VB-MAPP, ABLLS-R, PEAK, functional behavior assessments).
2. Evaluate goal operationalization, measurement systems, and intervention procedures to ensure they are evidence-based and individualized to each client.
3. Assess treatment plans for compliance with payer requirements, BACB ethical guidelines, and applicable state regulations.
4. Provide written feedback and actionable recommendations to supervising BCBAs and clinical teams to support timely plan revision and approval.
5. Track treatment plan submission timelines and approval statuses; escalate recurring deficiencies to clinical leadership.

Session Note Review — CPT 97153 & 97155

1. Review 97153 session notes (Adaptive Behavior Treatment by Protocol) for meeting clinical standards, including documentation of implemented protocols, data collection, prompting levels, and client response.
2. Review 97155 session notes (Adaptive Behavior Treatment with Protocol Modification) for appropriate BCBA direct involvement, protocol modifications, clinical rationale, and supervision documentation.
3. Identify documentation deficiencies—such as missing signatures, insufficient clinical detail, unsupported billing codes, or protocol drift—and communicate findings to clinicians.
4. Monitor trends in documentation errors and work collaboratively with clinical supervisors to address patterns through targeted training or process improvement.

Compliance & Quality Assurance

1. Maintain up-to-date knowledge of payer policies, BACB Professional and Ethical Compliance Code, and state licensure requirements as they relate to ABA documentation.
2. Assist in developing and refining internal quality audit tools, checklists, and standard operating procedures.
3. Support audit preparation and respond to payer documentation requests as needed.
4. Escalate documentation-related claim issues to VP of Quality & Compliance.
5.  Additional tasks assigned by the supervisor.