RCM Specialist - Ally Pediatric Therapy

The ABA Full Revenue Cycle Specialist is responsible for managing all aspects of the revenue cycle for ABA therapy services. Duties will vary but may include; insurance verification, authorization management, charge entry, claims submission, payment posting, and denial management. The specialist will work closely with clinical teams, payers, and families to ensure accurate and timely billing, optimize revenue, and provide support to families navigating the complexities of insurance coverage for autism services.

Key Responsibilities:

Charge Entry & Claims Submission:

- Accurately enter charges for ABA therapy sessions and other related services.

- Prepare and submit clean claims to insurance companies and other payers.

- Follow up on pending claims to ensure timely reimbursement.

Payment Reconciliation: (occasional)

- Post insurance and patient payments into the billing system.

- Reconcile payments against expected reimbursements and identify discrepancies.

- Address underpayments, overpayments, and adjustments with payers.

Denial Management & Appeals:

- Analyze and resolve claim denials, rejections, and discrepancies.

- Prepare and submit appeals to insurance companies when necessary.

- Collaborate with clinical staff to provide documentation supporting appeals.

Patient & Family Support:

- Assist families with understanding their insurance coverage and out-of-pocket responsibilities.

- Provide guidance on billing-related questions and concerns.

- Offer support in setting up payment plans when needed.

Reporting & Analytics:

- Familiarity with generating and analyzing revenue cycle reports to identify trends and areas for improvement.

- Participate in continuous process improvement initiatives to optimize revenue cycle efficiency.

Requirements

Experience:

- Minimum of 2-3 years of experience in medical billing, preferably with a focus on ABA therapy and autism services.

- In-depth knowledge of insurance plans, authorization processes, and payer requirements

- Experience with electronic health record (EHR) and billing systems.

Skills:

- Strong understanding of the full revenue cycle, including claims submission, payment posting, and denial management.

- Excellent organizational and time-management skills with the ability to manage multiple tasks and deadlines.

- Exceptional attention to detail and accuracy.

- Proficiency in using billing software and Microsoft Office Suite (Word, Excel, Outlook).

- Strong communication skills, both written and verbal, with the ability to explain complex billing issues to families and colleagues.

- Certified Professional Biller (CPB) or Certified Revenue Cycle Specialist (CRCS) preferred but not required.

- Interaction with various departments, including clinical staff, families, and insurance companies.

- Occasional extended hours may be required to meet billing deadlines.

Benefits

We offer:

- The opportunity to work with amazing people.

- The opportunity to make a difference.

- Competitive salary based on experience. $23 to $25 an hour.

- Comprehensive benefits package including health, dental, vision, and retirement plans.

- Opportunities for professional development and continuing education.