Job Title: ABA Insurance Operations Specialist
Working Hours: M-F 9:00 AM to 5:00 PM EST
Salary Range: $2,000-$3,000 (final offer depends on the client based on your skills and experience)

About the Company

Provides in-home Applied Behavior Analysis (ABA) therapy services for children diagnosed with autism across Indiana and New Jersey.

About the Role

We are seeking a highly experienced ABA Insurance Operations Specialist with true end-to-end hands-on experience in ABA insurance workflows. This is not an entry-level or support-only role.

The ideal candidate must be capable of independently owning and managing ABA insurance operations with minimal to no supervision. We are specifically looking for someone with direct ABA industry experience who can confidently handle verification of benefits, authorizations, claims follow-up, denials, resubmissions, and payer communications without requiring training.

This role is best suited for someone who is proactive, detail-oriented, highly organized, and experienced in navigating complex ABA insurance operations from start to finish.

Key Responsibilities

ABA Verification of Benefits (VOBs)

Complete ABA-specific verification of benefits from start to finish
Verify:
- authorization requirements
- deductible and out-of-pocket maximums
- copays and coinsurance
- in-network vs out-of-network benefits
- CPT code coverage
- ABA hour limits
- telehealth coverage
Work with both commercial and Medicaid payers
Accurately document and communicate benefit information to internal teams

ABA Authorizations & Reauthorizations

Independently submit ABA authorizations and reauthorizations
Prepare and manage required documentation including:
- diagnostic reports
- treatment plans
- assessments
- BCBA supporting documentation
Follow up with payers regarding pending authorizations
Handle denials and requests for additional information
Track authorization expiration dates and proactively manage reauthorization timelines
Work with ABA CPT codes including:
- 97151
- 97153
- 97155
- 97156

ABA Billing & Claims Follow-Up

Submit ABA claims to insurance payers
Follow up on unpaid, denied, rejected, or underpaid claims
Handle corrected claims, resubmissions, and appeals
Navigate payer portals and clearinghouse workflows efficiently
Identify and resolve billing issues independently
Experience with both in-network and out-of-network ABA claims strongly preferred

ABA Systems & Operational Workflows

Work within ABA operational systems and workflows
Prior experience working inside ABA companies is required
CentralReach and Rethink experience strongly preferred
Understand ABA operational workflows involving:
- BCBAs
- RBTs
- treatment plans
- supervision structures
- authorization cycles
- scheduling impact on billing and authorizations

Ownership & Process Improvement

Take full ownership of assigned insurance operations functions
Proactively identify issues and implement solutions
Aggressively follow through with payers and pending requests
Maintain organized workflows and accurate tracking systems
Communicate clearly and professionally with internal teams and insurance representatives
Escalate issues appropriately and manage deadlines independently
Support the development and improvement of internal insurance operations processes

Requirements

Proven ABA-specific insurance operations experience is required
Strong experience independently handling:
- ABA VOBs
- authorizations and reauthorizations
- claims follow-up
- denials and appeals
- resubmissions
- payer communications
Experience working with commercial and Medicaid insurance payers
Strong understanding of ABA CPT codes and authorization workflows
Excellent organizational and time management skills
Ability to work independently with minimal supervision
Strong written and verbal English communication skills
High attention to detail and accuracy
Experience using CentralReach and/or Rethink strongly preferred

Important Notes

Candidates must already have real ABA-specific insurance operations experience.
Generic medical billing or healthcare experience alone is not sufficient.
We are not looking for candidates who require training.
Candidates should already be comfortable independently managing ABA insurance workflows end-to-end.

ABA Insurance Operations Specialist - 19711