Website:
arohanasupport.com
Job details:
Position Summary
The ABA (Applied Behavior Analysis) Billing Lead is a management-level revenue cycle professional responsible for ensuring the accuracy, compliance, and financial performance of ABA billing operations across multiple client accounts. This role combines advanced billing expertise with client
relationship management, quality assurance, and team leadership to ensure billing teams consistently meet performance expectations while maximizing client revenue.
The ideal candidate has extensive hands-on experience with ABA billing across
commercial insurance and Medicaid, possesses exceptional analytical and
problem-solving skills, and is confident presenting billing data and recommendations
directly to clients. This individual serves as a subject matter expert, providing guidance
to billing teams while proactively identifying trends, reducing denials, and improving
overall revenue cycle performance.
Although this role provides leadership and oversight, it is also highly hands-on. The
Billing Lead must be willing to step into day-to-day billing activities, including claim
submission and account support, whenever necessary to ensure client success.
Essential Duties & Responsibilities
Client Account Management
● Serve as the primary billing expert for assigned client accounts.
● Build and analyze billing reports using client EHR systems.
● Present billing metrics, financial performance, and operational recommendations
to clients in a clear, professional manner.
● Monitor overall account health and identify opportunities for revenue
improvement.
● Develop trusted relationships with clients through proactive communication and
strategic guidance.
Quality Assurance & Billing Oversight
● Perform ongoing quality reviews of claims before and after submission to ensure
accuracy and compliance.
● Audit claims for:
○ ABA CPT codes and modifiers
○ Provider credentials and supervision requirements
○ Units, rates, authorizations, and service locations
○ Diagnosis codes
○ Payer-specific billing requirements
● Identify recurring billing trends, errors, and operational issues.
● Ensure billing activities comply with payer contracts, Medicaid regulations, and
industry best practices.
● Develop recommendations to improve billing accuracy and operational efficiency.
Revenue Cycle Performance
● Oversee billing production across assigned billing teams.
● Ensure claims are submitted accurately and within established timelines.
● Monitor key performance indicators, including:
○ Gross Collection Rate (GCR)
○ Days in Accounts Receivable
○ First-pass claim acceptance rate
○ Denial rate
○ Appeal turnaround time
● Hold teams accountable for meeting established quality and productivity
expectations.
● Escalate performance concerns and operational risks when appropriate.
Denials, Appeals & Collections
● Review and analyze claim denials across commercial and Medicaid payers.
● Determine root causes of denials and implement corrective actions.
● Provide coaching and direction to billing teams to prevent recurring issues.
● Oversee appeals, corrected claims, and payer follow-up activities.
● Ensure timely resolution of underpaid, denied, and outstanding claims.
Billing Operations
● Submit claims directly when needed to support billing teams, resolve urgent
issues, or address production backlogs.
● Validate claims prior to submission to maximize first-pass acceptance.
● Assist with corrected claims, payer resubmissions, and complex billing situations.
● Support process improvements that strengthen billing efficiency and revenue
integrity.
Cross-Functional Collaboration
● Communicate billing findings and recommendations to team leads, managers,
and clients.
● Provide clear guidance regarding:
○ What is incorrect
○ Why it is incorrect
○ How it should be corrected
○ How similar issues can be prevented
● Partner with Credentialing, Authorizations, Clinical Operations, and Client
Success teams to resolve issues affecting reimbursement.
● Serve as the organization's subject matter expert for ABA billing across multiple
payers and states.
Performance Expectations
Success in this position will be measured by:
● Reduction in claim errors and denial rates.
● Improved first-pass claim acceptance.
● Strong or improving Gross Collection Rate (GCR) across assigned clients.
● Timely identification and resolution of billing issues.
● Positive client satisfaction and communication.
● Consistent compliance with payer requirements and company quality standards.
- ● Achievement of team productivity and operational performance goals.
Click on Apply to know more.