Pearl Talent is hiring a Billing Lead to own the full revenue cycle for ABA providers, from eligibility and authorizations through clean claims, denials resolution, and reconciliation. This role is critical for ensuring timely payouts, accurate billing workflows, and operational visibility in a scaling healthcare operations context.
What You'll Do
- Oversee end-to-end billing for all credentialed ABA providers and clinics.
- Review and submit clean claims across Medicaid, commercial, and Tricare plans.
- Ensure accurate charge capture aligned with session logs, EVV data, and authorizations.
- Monitor clearinghouse rejections and correct errors within 24–48 hours.
- Manage denials, appeals, adjudications, and ongoing payer follow-up.
- Post EOBs/ERAs and reconcile deposits consistently and accurately.
- Oversee benefit checks, eligibility verification, and VOB workflows.
- Manage initial and ongoing prior authorizations for all clients.
- Track expiring authorizations and coordinate renewals with BCBAs and Intake teams.
- Ensure alignment between authorization limits, units, and billing operations.
- Maintain payer-specific rules across Medicaid, commercial, and Tricare.
- Ensure CPT coding accuracy (97151, 97153, 97155, 97156), modifiers, and documentation compliance.
- Collaborate with Product to resolve rule gaps and support billing automation improvements.
- Build, mentor, and manage billing specialists as the function scales.
- Develop SOPs, QA workflows, billing playbooks, and training materials.
- Partner with operational teams on claim statuses, blockers, and expectations.
- Work with Product/Engineering to enhance billing, posting, COB, and analytics tools.
- Maintain dashboards covering cash collected, AR aging, denials, and claim status.
- Identify trends, risk areas, and payer behavior changes.
- Provide leadership visibility into revenue cycle health and performance metrics.
What We're Looking For
- 3–5+ years of ABA medical billing or RCM experience.
- Deep understanding of ABA coding, modifiers, EVV, Medicaid rules, and authorization workflows.
- Experience supporting high-volume billing operations (20+ providers).
- Excellent written communication and documentation discipline.
- Ability to collaborate with engineering/design teams on tooling improvements.
- High attention to detail, accuracy, and operational follow-through.
- Ability to thrive in a fast-paced, scaling startup environment.
Nice to Have
- Experience with MSO structures or group NPI models.
- Background scaling RCM operations or leading billing teams.
- Familiarity with CO Medicaid, TX Medicaid, Tricare West, and multi-state commercial plans.
Technical Stack
- Candid, Availity, CO Medicaid InterChange / Gainwell, TX Medicaid TMHP, Tricare West (PGBA)
- Payspan, Clearinghouses, ERA/EOB posting tools
- Timekeeping / EVV-integrated systems, Internal RCM tracking dashboards
- Zelis, UHC Provider Express, Cigna/Evernorth portals, Aetna Medicaid portals, Optum provider tools
Team & Environment
Cross-functional collaboration with Intake, Scheduling, Payroll, Product, and operational teams.
Benefits & Compensation
- Competitive Salary: Based on experience and portfolio quality
- Remote Work: Fully remote—work from anywhere
- Performance-Based Bonus: Based on creative quality and timely project delivery
- Creative Growth: Long-term opportunity to lead major campaigns or projects
- Generous PTO: In accordance with company policy
- Health Coverage for Philippines-based talents: HMO coverage after 3 months for full-time employees
- Direct Mentorship: Guidance from international industry experts
- Learning & Development: Ongoing access to resources for professional growth
Work Mode
This is a fully remote, global position open to candidates in LATAM (Brazil, Colombia, Mexico, Argentina), the Philippines, and other remote regions with strong English communication and role-relevant experience.
Pearl Talent connects you with exceptional opportunities to grow, be challenged, and build a long-term, meaningful career.
