[Hiring] ABA Insurance Operations Specialist @Somewhere

Role Description

We are seeking a highly experienced ABA Insurance Operations Specialist with true end-to-end hands-on experience in ABA insurance workflows. This is not an entry-level or support-only role. The ideal candidate must be capable of independently owning and managing ABA insurance operations with minimal to no supervision.

We are specifically looking for someone with direct ABA industry experience who can confidently handle:

• Verification of benefits
• Authorizations
• Claims follow-up
• Denials
• Resubmissions
• Payer communications

This role is best suited for someone who is proactive, detail-oriented, highly organized, and experienced in navigating complex ABA insurance operations from start to finish.

Key Responsibilities

• ABA Verification of Benefits (VOBs)
  • Complete ABA-specific verification of benefits from start to finish
  • Verify:
    • Authorization requirements
    • Deductible and out-of-pocket maximums
    • Copays and coinsurance
    • In-network vs out-of-network benefits
    • CPT code coverage
    • ABA hour limits
    • Telehealth coverage
  • Work with both commercial and Medicaid payers
  • Accurately document and communicate benefit information to internal teams
• ABA Authorizations & Reauthorizations
  • Independently submit ABA authorizations and reauthorizations
  • Prepare and manage required documentation including:
    • Diagnostic reports
    • Treatment plans
    • Assessments
    • BCBA supporting documentation
  • Follow up with payers regarding pending authorizations
  • Handle denials and requests for additional information
  • Track authorization expiration dates and proactively manage reauthorization timelines
  • Work with ABA CPT codes including:
    • 97151
    • 97153
    • 97155
    • 97156
• ABA Billing & Claims Follow-Up
  • Submit ABA claims to insurance payers
  • Follow up on unpaid, denied, rejected, or underpaid claims
  • Handle corrected claims, resubmissions, and appeals
  • Navigate payer portals and clearinghouse workflows efficiently
  • Identify and resolve billing issues independently
  • Experience with both in-network and out-of-network ABA claims strongly preferred
• ABA Systems & Operational Workflows
  • Work within ABA operational systems and workflows
  • Prior experience working inside ABA companies is required
  • CentralReach and Rethink experience strongly preferred
  • Understand ABA operational workflows involving:
    • BCBAs
    • RBTs
    • Treatment plans
    • Supervision structures
    • Authorization cycles
    • Scheduling impact on billing and authorizations
• Ownership & Process Improvement
  • Take full ownership of assigned insurance operations functions
  • Proactively identify issues and implement solutions
  • Aggressively follow through with payers and pending requests
  • Maintain organized workflows and accurate tracking systems
  • Communicate clearly and professionally with internal teams and insurance representatives
  • Escalate issues appropriately and manage deadlines independently
  • Support the development and improvement of internal insurance operations processes

Qualifications

• Proven ABA-specific insurance operations experience is required
• Strong experience independently handling:
  • ABA VOBs
  • Authorizations and reauthorizations
  • Claims follow-up
  • Denials and appeals
  • Resubmissions
  • Payer communications
• Experience working with commercial and Medicaid insurance payers
• Strong understanding of ABA CPT codes and authorization workflows
• Excellent organizational and time management skills
• Ability to work independently with minimal supervision
• Strong written and verbal English communication skills
• High attention to detail and accuracy
• Experience using CentralReach and/or Rethink strongly preferred

Requirements

• Candidates must already have real ABA-specific insurance operations experience.
• Generic medical billing or healthcare experience alone is not sufficient.
• We are not looking for candidates who require training.
• Candidates should already be comfortable independently managing ABA insurance workflows end-to-end.