ABA Compliance Specialist

Gemma Services (formerly Silver Springs Martin Luther School); Philadelphia (Philadelphia County); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Paid time off

Medical, dental, vision benefits

Tuition reimbursement

403B with employer match

Wellness funds

Remote Fridays

Job summary

Gemma Services operates an ABA program from its Mt. Airy location, delivering services in schools, homes, and community settings. The role focuses on auditing billable notes, ensuring compliance with OMHSAS CBH standards, and supporting staff with documentation and billing processes.

The ideal candidate has a bachelor’s degree in a related field and at least three years of PA Medicaid behavioral healthcare experience, including claims processing and EHR usage.

Qualifications

• Bachelor’s degree in psychology, sociology, social services, or related field.
• Minimum 3 years experience in PA Medicaid behavioral healthcare and billing.
• Experience with claims processing and fiscal/billing workflows.

Responsibilities

• Audit and monitor billable notes prior to claim submission.
• Provide compliance training for staff to meet licensing standards.
• Provide real-time support to staff on notes, documentation, and billing.
• Recommend workflow improvements and conduct verification calls to families and schools.
• Ensure knowledge of local, state, and federal regulations for IBHS and ABA programs.
• Collaborate with fiscal department to resolve held/denied/ rejected claims.
• Maintain CBH data entry for authorizations in the EHR.
• Monitor MCO authorizations and communicate Medicaid eligibility.

Skills

Reading & writing

Interpersonal skills

EHR systems

Education

Bachelor's degree in psychology or related field

Tools

Electronic Health Records

Microsoft Office

Database management

Job description

Gemma Services has an ABA program operating out of our Mt. Airy location. Gemma Services emphasizes compassionate, individualized care designed to help youth, families, and adults feel supported and valued. Our mission is rooted in creating a world where every person feels seen and knows they matter.

Why Gemma? Gemma offers:

• Generous earned paid time off to be used for vacation, sick time, and personal days.
• Medical, dental and vision benefits
• Education assistance for tuition reimbursement and continuing education
• 403B with employer match
• In addition, Gemma offers self-care funds for each program to participate in wellness activities.
• Work schedule: Monday through Thursday in person, Fridays are remote.

The ABA Program provides services to children, youth, or young adults with diagnosis on the Autism Spectrum. Our services are provided in schools, homes, and the community by Behavioral Consultants, Mobile Therapists, and Behavioral Health Technicians.

This position is in person Monday through Thursday and remote on Fridays.

Responsibilities include:

• Audit and monitor billable notes submitted prior to claim submission for accurate date/time/duration/service/authorization/valid treatment plan/encounter form.
• Provide compliance training for newly hired and existing program staff to increase staff competencies and program service quality compliance with OMHSAS licensing requirements and CBH performance standards.
• Provide real-time support to direct care staff regarding their notes, required documentation, and billing authorizations.
• Recommend workflow processes that improve quality and efficiencies of programs; and conduct compliance/service verification calls to families and schools.
• Must be knowledgeable of local, county, state, and federal regulations/standards for the IBHS and ABA Programs, as well as all internal policies.
• Responsible for collaborating with the fiscal department in resolving held, denied, and rejected claims to facilitate timely billing.
• Maintain communication with CBH regarding billing authorizations and ensure accurate data entry of authorizations into our electronic health record.
• Monitor MCO websites for authorizations, manage insufficient responses, and distribute to assigned staff.
• Communicate with families about Medicaid eligibility.

Requirements: Proficient reading, writing, grammar, and mathematics skills; proficient interpersonal relations and communicative skills; proficient PC skills, including electronic health records, including Microsoft Office software and database management.

Experience: A minimum of three (3) years of experience preferred working in PA Medicaid behavioral healthcare program setting with electronic record keeping. Experience working in fiscal/billing department including claims processing.

Education: A bachelor’s degree in psychology, sociology, social service, population health, education, early education, or related field is required.

Required

Bachelors or better in Psychology or related field.

Experience

Preferred

3 years

Equal Opportunity Employer
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