Key Responsibilities:
- Review and process ABA and therapy medical records to ensure accurate, compliant billing
- Submit claims after verifying authorizations, units, modifiers, place of service, and rendering provider details
- Lead resolution of MCO-specific denials including authorization mismatches, unit overages, timely filing, missing modifiers, credentialing issues, and medical necessity reviews
- Independently work denials and underpayments from Texas Medicaid MCOs including Texas Children’s Health Plan (TCHP), Superior HealthPlan, WellPoint, Molina Healthcare, UnitedHealthcare Community Plan, and Community Health Choice
- Prepare and submit reconsiderations, appeals, corrected claims, and dispute packets in accordance with payer-specific timelines and requirements
- Manage commercial ABA payer denials with carriers such as Aetna, Cigna, Blue Cross Blue Shield of Texas, UnitedHealthcare, Tricare, and Optum
- Verify insurance eligibility and ABA authorization parameters (units, frequency, date ranges)
- Partner with clinicians and operations teams to correct documentation deficiencies and prevent repeat denials
- Utilize EMR platforms such as Raintree, KanTime, WebABA, or similar therapy-focused systems
Qualifications:
- 5+ years of ABA or pediatric therapy billing experience
- Demonstrate expertise resolving Texas Medicaid MCO denials (TCHP, Superior, Amerigroup, Molina, UHC Community, CHC)
- Strong knowledge of ABA authorization structures, unit limits, and modifier requirements
- Experience billing commercial ABA carriers (Aetna, Cigna, BCBS TX, UHC, Tricare, Optum)
- EMR experience with Raintree, KanTime, WebABA strongly preferred
- Advanced attention to detail, follow-through, and compliance
Compensation & Growth:
- Pay Range: $24.00 – $32.00 per hour
- Includes a 90-day performance review with potential compensation evaluation