Quality Assurance Specialist (BCBA)

About the role

At Carelinks ABA, clinical quality isn't just about providing great ABA—it also means understanding the complex payer and regulatory landscape that determines how care is documented, authorized, and maintained. We're looking for an experienced BCBA who understands both sides of that equation: strong clinical care and the payer requirements that support it. Our Quality Assurance Specialist (QAS) will help ensure our clinical practices, documentation, and systems remain clinically meaningful while meeting the expectations of Medicaid programs, managed care organizations, commercial insurers, and other funding sources. This is not a traditional full-caseload BCBA role. It's an opportunity for an experienced clinician with strong payer and compliance knowledge to influence clinical quality across a growing organization.

What You'll Do

You'll work closely with our VP of Clinical Operations, Area Clinical Directors, BCBAs, authorization, billing, and operational teams to bridge the gap between clinical excellence and payer expectations.

• Stay current on payer policies, authorization requirements, medical necessity standards, CASP guidance, and regulatory changes impacting ABA
• Translate complex payer requirements into clear, practical guidance for our clinical teams
• Review treatment plans, assessments, reassessments, progress notes, BSPs, authorization documentation, and other clinical records for quality and compliance
• Analyze denials, partial approvals, authorization feedback, and payer audits to identify trends and prevent recurring issues
• Train and coach BCBAs on documentation, treatment planning, medical necessity, and payer-specific expectations
• Develop and maintain internal audit processes, clinical policies, SOPs, documentation templates, and quality standards
• Partner across clinical, authorization, billing, and operations teams when payer changes or quality concerns require organization-wide action
• Monitor clinical quality indicators and proactively identify areas of risk
• Support incident reporting, SafetyCare standards, ethics and compliance initiatives, and fraud, waste, and abuse prevention
• Monitor AI-supported documentation quality tools and use findings to drive clinician education and process improvement

Who We're Looking For

We're looking for more than an experienced BCBA. We want someone who truly understands the ABA payer landscape. You should be comfortable navigating the relationship between clinical recommendations, medical necessity, documentation, authorization requirements, and reimbursement. When a payer changes its expectations or an authorization comes back with questions, you should know how to dig into the issue, understand what is driving it, and help the organization respond appropriately.

• Master's degree or higher in Applied Behavior Analysis, Psychology, or a related field
• Active BCBA certification in good standing
• 3+ years of certified clinical ABA experience, including supervisory responsibilities
• Strong working knowledge of Medicaid, managed care, and commercial payer requirements within ABA
• Experience with treatment authorizations, medical necessity standards, clinical documentation requirements, and payer audits or reviews
• Ability to interpret payer policies and translate them into practical clinical workflows
• Strong understanding of CASP guidance, ABA documentation standards, HIPAA/PHI requirements, ethics, and clinical compliance
• Exceptional attention to detail and ability to recognize patterns across clinical and payer data
• Strong communication, training, coaching, and cross-functional collaboration skills
• Experience with multiple payers and/or multiple state Medicaid programs, clinical audits, authorization denials, corrective-action processes, policy development, or organizational quality assurance is strongly preferred

Clinical Caseload

The QAS will remain connected to clinical practice while having the capacity to focus on organization-wide quality. The position carries a reduced caseload of approximately 2-4 clients, with an expectation of approximately 15 billable hours per week.