Job Overview

We are seeking a highly experienced ABA Credentialing & Authorization Specialist to take full ownership of payer-side operations within our Applied Behavior Analysis (ABA) practice.

This is not a billing-first role. The primary focus is on credentialing, contracting, authorizations, and insurance verification workflows, ensuring providers are fully set up and services are authorized, compliant, and reimbursable.

You will function as a subject matter expert (SME) in ABA revenue cycle management (RCM), working independently to manage processes end-to-end and resolve payer-related issues.

Work Schedule: 40hrs per week, 9am - 5pm Eastern Time

Key Responsibilities

Credentialing & Contracting

• Manage end-to-end credentialing for BCBAs and RBTs
• Handle payer enrollment, contracting, and revalidation processes
• Follow up consistently with insurance payers to ensure timely approvals
• Escalate stalled applications and resolve credentialing issues proactively

Authorizations

• Submit, track, and manage prior authorizations for ABA services
• Monitor authorization statuses and ensure timely renewals
• Troubleshoot and resolve authorization-related delays or denials

Verification of Benefits (VOB)

• Perform accurate, detailed VOBs (not surface-level checks)
• Interpret coverage for ABA-specific CPT codes (e.g., 97153, 97155)
• Clearly document eligibility, limitations, and payer-specific rules

Denials Management (Non-Billing Focus)

• Handle denials related to:
  • Authorization issues
  • Credentialing gaps
  • Eligibility discrepancies
• Coordinate directly with payers to resolve issues efficiently

Payer Communication

• Act as the primary point of contact with insurance carriers
• Push for resolutions, follow through on pending issues, and escalate when necessary

Secondary / Nice-to-Have Responsibilities

• Support out-of-network (OON) billing if needed (not the primary focus)
• Familiarity with billing platforms such as Camber is a plus

Requirements 

• Mandatory: Direct experience in the ABA (Applied Behavior Analysis) industry
• Strong knowledge of ABA workflows and CPT codes (e.g., 97153, 97155)
• Proven experience with:
  • Credentialing and contracting (US healthcare payers)
  • Prior authorizations
  • Verification of Benefits (VOB)
• Experience working with:
  • Medicaid MCOs
  • Commercial insurance payers for ABA services
• Deep understanding of US healthcare insurance systems and payer processes
• Strong problem-solving skills and persistence in dealing with payers

Seniority Level

• Senior-level / SME
• Able to own processes end-to-end
• Proactive in pushing payers and resolving complex issues
• Comfortable working autonomously with minimal supervision

Independent Contractor Perks

• Health insurance in eligible locations

• Permanent work from home

• Immediate hiring

Note

• Please click the "Apply" button to complete your application, including the assessment questions, technical check, and voice recording. Your hourly pay rate will be established based on your performance in the application process; submissions with all requirements fulfilled will receive priority review.