Medical Licensing Verifications Specialist, ABA Therapy

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

📋 Description

• Oversee the credentialing process for insurance and medical licensing for newly recruited clinicians.

• Refresh documentation and portal profiles with individual insurance providers to guarantee compliance and accurate billing.

• Investigate the insurance landscape in new states and pinpoint insurers to prioritize for network inclusion.

• Reach out to insurance firms to comprehend credentialing prerequisites, application procedures, and reimbursement rate frameworks.

• Negotiate reimbursement rates when proposed rates fall short of competitive standards.

• Monitor the progress of credentialing and contracting, proactively identifying delays or challenges.

• Maintain precise, audit-ready documentation across various insurer portals and systems.

• Adhere to established workflows and escalate issues as needed.

• Undertake ad hoc coordination tasks as required.

• Provide support for a U.S.-based, multi-state provider of Applied Behavior Analysis therapy services for children with autism.

⛳️ Requirements

• Experience in U.S. health insurance, encompassing private insurers and Medicaid.

• Exceptional communication abilities and strong proficiency in English (both verbal and written).

• Strong critical thinking and independent problem-solving skills, especially related to contracting and negotiation aspects of the role.

• Confident and proactive demeanor; comfortable initiating dialogue with insurers and advocating for improved terms.

• Detail-oriented and highly organized, with the discipline to accurately manage multiple portals and deadlines.

• Basic computer skills, including MS Office and Outlook; advanced Excel skills are not required.

• Experience with ABA-specific insurance processes is advantageous but not mandatory.

• Capacity to work independently with minimal daily oversight.

• Availability to work Monday to Friday, from 15:00 to 00:00 South African time, subject to daylight-saving adjustments.

• Minimum 25 Mbps fixed fiber internet connection for upload and download, capable of supporting a wired Ethernet connection.

• Reliable power backup solution capable of maintaining internet and workstation functionality during load shedding and power outages.

🏝️ Benefits

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

• Fully remote working position.

• Requirement of fixed fiber internet supporting a wired Ethernet connection.

• Reliable power backup solution (solar, inverter, or UPS) is essential.