ABA Billing Specialist

SpringHealth Behavioral Health and Integrated Care

Join a team where your expertise directly drives financial accuracy and operational excellence. At SpringHealth Behavioral Health & Integrated Care we are a clinically led organization committed to delivering high-quality person-centered careand our billing team plays a critical role in sustaining that mission.

We are seeking an experienced ABA Billing Specialist who thrives in a fast-paced detail-driven environment and takes pride in getting it right the first this role you will:

• Serve as a key owner of ABA billing accuracy across commercial payers and Medicaid
• Act as a quality gatekeeper for claims ensuring clean submissions and minimized denials
• Analyze billing trends identify errors and proactively drive corrective actions
• Partner cross-functionally with clinical operations and finance teams to resolve issues and improve processes
• Support strong gross collection performance and protect overall revenue integrity
• Monitor and manage denials collections and reporting with a high level of accountability
• Communicate insights clearly to leadership and influence process improvements

This role is ideal for someone who is:

• Highly detail-oriented and analytical with a strong sense of ownership
• Experienced in ABA billing and confident navigating payer requirements
• Comfortable working independently while driving cross-functional collaboration
• Passionate about continuous improvement and operational excellence

This is more than a billing roleits an opportunity to make a measurable impact on financial performance while supporting the delivery of life-changing clinical services.

Key Responsibilities Quality Assurance & Oversight:

• Perform ongoing quality audits of claims prior to and after submission to ensure accuracy compliance and payer-specific requirements are met.
• Review claims for correct:
• CPT codes and modifiers (e.g. 97158)
• Provider credentials and supervision requirements
• Units rates authorizations and service locations
• Diagnosis codes and payer-specific billing rules
• Identify billing trends recurring errors and systemic issues impacting claims payments or denials.
• Ensure all billing processes align with ABA best practices payer contracts and state Medicaid guidelines.

Denials Collections & Follow-Ups:

• Review and analyze denials across commercial and Medicaid payers.
• Identify root causes of denials and provide clear actionable guidance to team leaders on how to prevent recurrence.
• Support and oversee collections and follow-up efforts to ensure underpaid or denied claims are resolved appropriately.
• Ensure appeals are accurate complete and submitted within payer deadlines.

Claims Submission & Direct Billing Support

• Ensure claims are scrubbed and validated prior to submission to maximize first-pass acceptance.
• Assist with payer re-submissions corrected claims and appeal filings as required.

Communication & Cross-Team Collaboration

• Communicate findings clearly and professionally to team leaders managers and stakeholders.
• Provide concise feedback on:
• What is incorrect
• Why is it incorrect
• What must be fixed
• How to prevent future errors
• Collaborate with credentialing authorizations and clinical documentation teams to resolve upstream issues impacting billing.
• Serve as a subject-matter expert (SME) for ABA billing questions across payers and states.

Required Qualifications

• 5 years of hands-on ABA billing experience including both commercial payers and Medicaid.
• In-depth knowledge of:
• ABA CPT codes and modifiers
• Authorization requirements
• Supervision and rendering provider rules
• State-specific Medicaid billing nuances
• Proven experience working with denials appeals collections and payer follow-ups.
• Strong understanding of revenue cycle metrics including GCR and A/R management.
• High level of proficiency in billing systems and clearinghouses (e.g. Rethink Availity Waystar etc.).

Core Competencies & Skills

• Exceptional attention to detail consistently catches errors others miss.
• Highly self-motivated able to manage workload independently and prioritize effectively.
• Clear and confident communicator able to give direct professional feedback to team leads and stakeholders.
• Analytical mindset able to identify trends root causes and data-driven solutions.
• High accountability takes ownership of outcomes and revenue integrity.
• Process-driven values structure documentation and consistency.
• Collaborative but firm able to influence teams while maintaining high standards.

Performance Expectations

Success in this role is measured by:

• Reduced claim error rates and denials
• Improved first-pass acceptance rates
• Timely identification and correction of billing issues
• Clear actionable communication with team leads
• Consistent adherence to compliance and quality standards