Revenue Cycle Management (RCM) Billing Specialist

About the role

The RCM Billing Specialist at Children’s Specialized ABA is responsible for the accurate and timely submission of multidisciplinary healthcare claims, with a primary focus on Applied Behavior Analysis (ABA) services. This role reports to the RCM Billing Manager.

Responsibilities

• Claims Submission
• Submit weekly batches of primary claims for ABA and other multidisciplinary services through CentralReach and Waystar.
• Review claims for completeness, accuracy, and compliance prior to submission.
• Ensure timely filing requirements are met for all assigned payers.
• Maintain claim submission reports and address any rejections or submission errors collaborating with management on any issues or trends.
• Secondary Claims Processing
• Prepare and submit secondary claims accurately and timely.
• Verify primary claim adjudication and coordinate benefits requirements prior to submission.
• Maintain documentation supporting secondary claim submissions.
• Billing Operations Support
• Work closely with the RCM Billing Manager to identify and communicate billing issues, claim submission barriers, outstanding claim items, escalations requiring leadership review, and participate in workflow discussions and process improvement initiatives.
• Maintain organized tracking of claim submission activities and follow up items.
• Claim Corrections and Adjustments
• Process corrective claims as directed by the RCM Manager or Director.
• Submit void and replacement claims when requested by Quality Assurance (QA), Compliance, or Revenue Cycle leadership.
• Absorb assistance with claim correction projects and payer specific billing requirements.
• Compliance and Quality
• Follow all company policies, payer guidelines, and regulatory requirements.
• Maintain accurate documentation of billing activities.
• Support internal audits and quality reviews as requested.
• Ensure confidentiality and protection of protected health information (PHI) in accordance with HIPAA regulations.

Requirements

• Minimum of 1 year of hands-on experience using CentralReach for healthcare billing.
• Minimum of 2 years of medical billing experience, preferably within ABA, behavioral health, therapy, or multidisciplinary healthcare services.
• Experience utilizing claim clearinghouses such as Waystar.
• Knowledge of insurance billing fundamentals, claim submission processes, and payer requirements.
• Strong attention to detail and organizational skills.
• Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
• Proficiency in Microsoft Excel, Outlook, and other standard business applications.
• Strong written and verbal communication skills.

Qualifications

• Required Qualifications:
• Minimum of 1 year of hands-on experience using CentralReach for healthcare billing.
• Minimum of 2 years of medical billing experience, preferably within ABA, behavioral health, therapy, or multidisciplinary healthcare services.
• Experience utilizing claim clearinghouses such as Waystar.
• Knowledge of insurance billing fundamentals, claim submission processes, and payer requirements.
• Strong attention to detail and organizational skills.
• Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
• Proficiency in Microsoft Excel, Outlook, and other standard business applications.
• Strong written and verbal communication skills.
• Preferred Qualifications:
• 3+ years of CentralReach billing experience.
• ABA billing experience.
• Experience with multidisciplinary billing environments including behavioral health, speech therapy, occupational therapy, physical therapy, or related services.
• Experience processing secondary claims, corrective claims, and void/replacement claims.
• Familiarity with Medicaid, commercial insurance, and managed care payer billing requirements.

Pay

$24.00 - $28.00 per hour.

Schedule

This position may be performed remotely or in a hybrid environment based on business needs. Availability expected between 8:30am - 5:00pm EST. Must reside in one of the following states: FL, IL, IN, MD, MI, MO, NC, NY, OH, PA, TX, or VA. Candidates must maintain reliable internet access and be able to work independently while collaborating effectively with team members and leadership.