Medical Biller (US Shift, WFH)

Key Responsibilities

• Submit and manage ABA therapy insurance claims, including claims involving commonly used ABA CPT codes.
• Verify patient insurance eligibility, benefits, and coverage requirements.
• Track prior authorizations and service authorizations for ABA services.
• Monitor claims from submission through payment, including follow-ups with insurance providers.
• Investigate and resolve claim denials, rejections, underpayments, and payment discrepancies.
• Post insurance and patient payments accurately and maintain accounts receivable records.
• Review clinical documentation and billing information to ensure accuracy and compliance.
• Communicate billing-related concerns with clinical and administrative teams.
• Prepare billing reports, assist with audits, and maintain patient confidentiality in accordance with HIPAA requirements.

Qualifications

• At least 3 years of medical billing experience in a healthcare setting.
• Previous ABA therapy billing experience is strongly preferred.
• Knowledge of ABA CPT codes, insurance claims, payer requirements, and authorization processes.
• Experience with claim denials, appeals, payment posting, and accounts receivable.
• Strong understanding of insurance eligibility and benefits verification.
• Familiarity with electronic medical records (EMR), practice management, or billing software.
• Excellent attention to detail, organization, communication, and problem-solving skills.
• Ability to manage multiple priorities and meet billing deadlines.
• Knowledge of HIPAA and healthcare privacy requirements.

Preferred Qualifications

• Experience working with Medicaid and commercial insurance payers.
• Familiarity with ABA-specific billing platforms and authorization requirements.
• Experience handling appeals and reconsiderations for denied claims.
• Background in behavioral health or pediatric healthcare revenue cycle management.