ABA Insurance Verifications, QA Specialist

This is a fully remote position, open to applicants in South Africa.

📋 Description

• Retrieve benefit checks from the Monday.com board for new inquiries and for existing clients who modify their insurance.

• Contact US insurers to confirm out-of-network benefits related to ABA, occupational therapy, speech and language, and associated services.

• Verify coverage details or exclusions, visit limitations, deductibles, co-insurance, and total out-of-pocket expenses.

• Accurately document insurance benefits on the board.

• Dispatch patient responsibility contracts to parents following the agreement of payment plans and follow up until signed contracts are returned.

• Enter real or placeholder authorizations into CentralReach for billing purposes by therapists.

• Extend or renew authorizations prior to January and re-verify all clients' benefits during the first two weeks of January.

• Examine flagged session notes in CentralReach and NoteGuard AI.

• Ensure that amendment notes are signed and labeled clearly so that sessions can proceed to payroll.

• Resolve internal rule flags when feasible and escalate issues to therapists as necessary.

• Over time, assist with authorization utilization checks, timesheet authorization concerns, and follow up on unconverted timesheets.

• Provide support to a small in-office team in a fully remote back-office role, with the potential to transition into staff-facing responsibilities.

⛳️ Requirements

• Experience in the ABA industry with a strong grasp of terminology including timesheets, goals, session notes, QA, and authorizations; experience in ABA recruiting, onboarding, or administration is acceptable.

• Comfortable communicating with US insurers over the phone.

• Proficient in Microsoft 365 applications, including Outlook and Excel.

• Exceptional written and verbal English skills.

• Strong attention to detail and precision.

• Proactive attitude to question any discrepancies rather than simply adhering to the workflow.

• Consistent habit of providing comprehensive and proactive communication, offering substantial updates instead of one-word responses.

• Confident and personable demeanor, with an ability to collaborate effectively with others.

• Experience with CentralReach is advantageous.

• Familiarity with Monday.com is a plus.

• Background in US health insurance or benefits verification, especially in ABA, OT, and speech, is beneficial.

• Experience working with US or international clients is a plus.

• A creative thinker who demonstrates initiative, engages in discussions, asks questions, and communicates effectively.

• A friendly, approachable, and open personality.

• Reliable fixed fiber internet connection with a minimum upload and download speed of 25 Mbps, supporting a wired Ethernet setup.

• Dependable power backup solution for load shedding and power interruptions.

• Must reside in South Africa.

• Required to work Monday to Friday, from 16:00 to 01:00 SAST, adjusted for US daylight saving time changes.

• Availability to work on South African and U.S. public holidays is necessary.

🏝️ Benefits

• Compensation for South African public holidays in line with the BCEA.

• Fully remote working setup.

• Standard working hours from Monday to Friday.