SpringHealth Behavioral Health and Integrated Care

Join a team where your expertise directly drives financial accuracy and operational excellence. At SpringHealth Behavioral Health & Integrated Care, we are a clinically led organization committed to delivering high-quality, person-centered care—and our billing team plays a critical role in sustaining that mission.

 

We are seeking an experienced ABA Billing Specialist who thrives in a fast-paced, detail-driven environment and takes pride in getting it right the first time. In this role, you will:

• Serve as a key owner of ABA billing accuracy across commercial payers and Medicaid
• Act as a quality gatekeeper for claims, ensuring clean submissions and minimized denials
• Analyze billing trends, identify errors, and proactively drive corrective actions
• Partner cross-functionally with clinical, operations, and finance teams to resolve issues and improve processes
• Support strong gross collection performance and protect overall revenue integrity
• Monitor and manage denials, collections, and reporting with a high level of accountability
• Communicate insights clearly to leadership and influence process improvements

This role is ideal for someone who is:

• Highly detail-oriented and analytical, with a strong sense of ownership
• Experienced in ABA billing and confident navigating payer requirements
• Comfortable working independently while driving cross-functional collaboration
• Passionate about continuous improvement and operational excellence

This is more than a billing role—it’s an opportunity to make a measurable impact on financial performance while supporting the delivery of life-changing clinical services.

Key Responsibilities Quality Assurance & Oversight:

• Perform ongoing quality audits of claims prior to and after submission to ensure accuracy, compliance, and payer-specific requirements are met.
• Review claims for correct:
• CPT codes and modifiers (e.g., 97151, 97153, 97155, 97156, 97158,)
• Provider credentials and supervision requirements
• Units, rates, authorizations, and service locations
• Diagnosis codes and payer-specific billing rules
• Identify billing trends, recurring errors, and systemic issues impacting claims, payments, or denials.
• Ensure all billing processes align with ABA best practices, payer contracts, and state Medicaid guidelines.

Denials, Collections & Follow-Ups:

• Review and analyze denials across commercial and Medicaid payers.
• Identify root causes of denials and provide clear, actionable guidance to team leaders on how to prevent recurrence.
• Support and oversee collections and follow-up efforts to ensure underpaid or denied claims are resolved appropriately.
• Ensure appeals are accurate, complete, and submitted within payer deadlines.

Claims Submission & Direct Billing Support

• Ensure claims are scrubbed and validated prior to submission to maximize first-pass acceptance.
• Assist with payer re-submissions, corrected claims, and appeal filings as required.

Communication & Cross-Team Collaboration

• Communicate findings clearly and professionally to team leaders, managers, and stakeholders.
• Provide concise feedback on:
• What is incorrect
• Why is it incorrect
• What must be fixed
• How to prevent future errors
• Collaborate with credentialing, authorizations, and clinical documentation teams to resolve upstream issues impacting billing.
• Serve as a subject-matter expert (SME) for ABA billing questions across payers and states.

Required Qualifications

• 5+ years of hands-on ABA billing experience, including both commercial payers and Medicaid.
• In-depth knowledge of:
• ABA CPT codes and modifiers
• Authorization requirements
• Supervision and rendering provider rules
• State-specific Medicaid billing nuances
• Proven experience working with denials, appeals, collections, and payer follow-ups.
• Strong understanding of revenue cycle metrics, including GCR and A/R management.
• High level of proficiency in billing systems and clearinghouses (e.g., Rethink, Availity, Waystar, etc.).

Core Competencies & Skills

• Exceptional attention to detail — consistently catches errors others miss.
• Highly self-motivated — able to manage workload independently and prioritize effectively.
• Clear and confident communicator — able to give direct, professional feedback to team leads and stakeholders.
• Analytical mindset — able to identify trends, root causes, and data-driven solutions.
• High accountability — takes ownership of outcomes and revenue integrity.
• Process-driven — values structure, documentation, and consistency.
• Collaborative but firm — able to influence teams while maintaining high standards.

Performance Expectations

Success in this role is measured by:

• Reduced claim error rates and denials
• Improved first-pass acceptance rates
• Timely identification and correction of billing issues
• Clear, actionable communication with team leads
• Consistent adherence to compliance and quality standards

SpringHealth Behavioral Health and Integrated Care, an affiliate of BrightSpring Health Services, offers a holistic approach and integrated care for people with cognitive, developmental, or intellectual disabilities who often need additional resources. The behavior analysts, therapists, social workers, counselors, and psychologists at SpringHealth combine their expertise to deliver high-quality behavioral services for clients to live more positive, active, and social lives. For more information, please visit www.springhealthbehavioral.com. Follow us on Facebook and LinkedIn.