INTERNAL ONLY Medical Necessity Specialist

Action Behavior Centers - ABA Therapy for Autism; Texas; Remote; USD 60,000 - 90,000; Full time

Benefits offered by this job

PTO & Holidays

Student loan repayment

Maternity/Paternity award

Transit/meal perks

401K with company matching

Tuition discounts

Job summary

Action Behavior Centers, a leading ABA therapy provider, seeks a Remote Internal Medical Necessity Specialist to support clinical services and authorization workflows. The role involves documenting patient interactions, coordinating with insurance providers, and ensuring accurate electronic records for multiple ABC locations.

The ideal candidate is an RBT with field experience or an RBT in a BCBA pathway, with strong communication, organizational skills, and familiarity with HIPAA-compliant data

Qualifications

• RBT certification and field experience preferred.
• Familiarity with Salesforce is advantageous but not required.
• Strong understanding of Applied Behavior Analysis (ABA) therapy is recommended.
• Experience negotiating with insurance companies is beneficial.
• Extremely detail oriented to minimize impact on patient care.
• Excellent organizational and communication skills for fast-paced, remote work.

Responsibilities

• Assist Regional Autism Advocates in communicating with insurance providers.
• Review and verify patient intake paperwork and reports for insurance authorization.
• Manage patient paperwork in Salesforce and ensure HIPAA-compliant handling of data.
• Coordinate with corporate team and office managers across ABC locations.
• Schedule and participate in Peer-to-Peer calls with insurance and BCBAs as needed.
• Maintain and update patient authorization information in the EMR/billing system.

Skills

RBT

Salesforce

ABA knowledge

Insurance negotiation

Attention to detail

Organizational skills

Job description

Position:INTERNAL ONLY Medical Necessity Specialist

Location: Remote

Job Id:34753

# of Openings:1

ABC Story:

Our story began in 2017 in Austin, TX. We started with humble roots but big aspirations. From 1 center in North Austin, our movement has inspired thousands of clinicians and operators. Today, the ABC community is 10,000+ strong serving thousands of children with ASD. Growth with intentionality: We have an intentional focus on our core values. Each center is purpose-built, and each community of teammates is nurtured.

Summary:

We are looking for an assertive and driven clinical professional to join our team in a crucial administrative role to help our ABA Therapy organization grow! Action Behavior Centers is a leading development organization for children with autism based out of Austin, Texas. With numerous clinics opening up across the United States, we need someone who shares our vision for expansion and wants to help take us there. Our Corporate Team needs someone passionate about helping kiddos with autism get the therapy they need. This role will support the Vice President of Clinical Services, the Director of Clinical Advocacy and Authorizations, and the Regional Autism Advocate(s) with time-sensitive documentation fidelity and discuss clinical needs with insurance companies. The ideal candidate will be a RBT having worked in the field with various demographics of children impacted with Autism and has a hunger for continued growth in knowledge of ABA & Autism services, OR a Registered Behavior Technician (RBT) completing their Master’s Program to become a Board Certified Behavior Analyst (BCBA) with only indirect hours left to be able to sit for the Behavior Analyst Certification Board (BACB) Exam to become a BCBA would be ideal.

Requirements:

• Familiarity with SalesForce is recommended but not required
• Registered Behavior Technician (RBT) required; An RBT with 2+ years of clinical experience is preferred
• Working knowledge and understanding of Applied Behavior Analysis (ABA) therapy is strongly recommended
• Previous experience negotiating with insurance companies
• A strong, pleasant personality with a high EQ
• Extremely detail oriented – you minimize mistakes because you care about how your work affects patients
• Assertive and strong communication style - you know how to get what you want because you can eloquently present the facts and advocate for patient services
• You possess a high-level of organizational skills - you rarely drop the ball because you love having systems in place to keep things running smoothly
• You like to work really hard – you aren’t watching the clock for quittin’ time because there is always more than needs to be done, and you like that
• Undergraduate is ideal but not required

Responsibilities:

• Assisting Regional Autism Advocate(s) in campaigning to insurance companies on patient services
• Review and confirm patient intake paperwork
• Review & proof read patient reports provided by BCBAs and prepare patient documents for insurance authorization requirements
• Manage & upkeep patient paperwork in SalesForce
• Participate in meetings with the Corporate Team
• Maintain patient communication with the Office Managers across all ABC locations
• Assist Regional Autism Advocate(s) and Director of Clinical Advocacy and Authorizations with Ad Hoc projects. This may also be inclusive of Ad Hoc projects from our Vice President of Clinical Services.
• Oversees and maintains the company's healthcare data entry procedures within HIPAA compliance guidelines.
• Confirm authorization via phone calls, and enter authorization documents quickly and accurately.
• Confirm, maintain and enter patient's healthcare and authorization information with sensitivity and discretion into the EMR/billing system.
• Fax and submit for authorization of treatment.
• Schedule Peer-to-Peer (P2P) calls for insurance companies; This includes scheduling P2P calls for our BCBAs regarding general or specific clinical case discussions, etc.
• Account for submission and resubmission to new insurance companies with updated paperwork

**This position is remote (quarterly/semi-annual travel to Austin). If in Austin, 2x per week attendance in HQ is required.**

• 10 Days of PTO, 10 Paid Holidays, 2 Flex Days + More with Tenure
• Student Loan Repayment Employer Contributions
• Maternity/Paternity Award of up to $3,000 & FSA Options for Childcare
• Door Dash Pass and Regional Night of Honors
• Up to $600 Student Loan Repayment Options & Tuition Discounts

Additional Rewards:

• Professional development: we want to pour into you as you pour into ABC
• Leadership opportunities: To be the best, we have to continually keep learning and you get to push yourself here to learn more and take on more responsibilities, and show what you can do!
• 401K Retirement Plans with company matching

See what others have said when they made the decision to grow with us!

ABC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, age, religion, sex, sexual orientation, gender identity or expression, national origin, ancestry, disability, marital status, genetic information, veteran status, or any other status protected by applicable federal, state, or local laws, including the Pennsylvania Human Relations Act (PHRA). We are committed to creating an inclusive environment for all employees.