ABA Compliance Specialist

Gemma Services•Philadelphia, PA

5d•Hybrid

About The Position

Gemma Services is hiring an ABA Compliance Specialist for its ABA program at the Mt. Airy location. The program serves children, youth, and young adults diagnosed with Autism Spectrum conditions, with services provided in schools, homes, and the community by Behavioral Consultants, Mobile Therapists, and Behavioral Health Technicians. The position is in person Monday through Thursday and remote on Fridays. The specialist audits and monitors billable notes before claim submission, supports staff with documentation and billing authorizations, provides compliance training, and helps ensure adherence to applicable regulations and standards. The role also works with the fiscal department to resolve claim issues, communicates with CBH about authorizations, monitors MCO websites, and communicates with families about Medicaid eligibility.

Requirements

Bachelor’s degree in psychology, sociology, social service, population health, education, early education, or a related field.
Proficient reading, writing, grammar, and mathematics skills.
Proficient interpersonal relations and communication skills.
Proficient PC skills, including electronic health records, Microsoft Office software, and database management.

Nice To Haves

A minimum of three years of experience working in a Pennsylvania Medicaid behavioral healthcare program setting with electronic record keeping is preferred.
Experience working in a fiscal or billing department, including claims processing.

Responsibilities

Audit and monitor billable notes before claim submission for accuracy of date, time, duration, service, authorization, valid treatment plan, and encounter form.
Provide compliance training to newly hired and existing program staff to improve staff competencies and service quality compliance with OMHSAS licensing requirements and CBH performance standards.
Provide real-time support to direct care staff regarding notes, required documentation, and billing authorizations.
Recommend workflow processes that improve program quality and efficiency.
Conduct compliance and service verification calls to families and schools.
Maintain knowledge of local, county, state, and federal regulations and standards for IBHS and ABA programs, as well as internal policies.
Collaborate with the fiscal department to resolve held, denied, and rejected claims and facilitate timely billing.
Maintain communication with CBH regarding billing authorizations and ensure accurate entry of authorizations into the electronic health record.
Monitor MCO websites for authorizations, manage insufficient responses, and distribute authorizations to assigned staff.
Communicate with families about Medicaid eligibility.