Documentation and Compliance Associate

ABA Support Services LLC • Bethlehem, PA

20h

About The Position

The Documentation and Compliance Associate will be responsible for reviewing and scoring progress notes, ensuring documentation meets regulatory and payer standards, identifying documentation gaps, and communicating required corrections. This role also involves supporting claims reviews and appeals, coordinating insurance pre-authorizations, and maintaining accurate data across all systems. Additionally, the associate will provide administrative support, stay current with payer policies, and maintain a reference library for appeals.

Requirements

• Experience with clinical documentation review.
• Understanding of regulatory and payer standards.
• Ability to identify documentation gaps, errors, and inconsistencies.
• Proficiency in evaluating notes against benchmarks and scoring criteria.
• Strong communication skills for providing feedback and recommendations.
• Accuracy in documenting and tracking reviews.
• Experience with tracking systems for monitoring progress notes.
• Ability to support claims reviews and appeals.
• Experience partnering with billing and clinical teams.
• Familiarity with updating client records and service details.
• Experience auditing non-billable time entries.
• Skills in coordinating insurance pre-authorizations and appeals.
• Ability to gather required documentation and prepare submission materials.
• Experience maintaining a reference library.
• Collaboration skills with internal teams and external representatives.
• Proficiency in maintaining accurate data across systems.
• Ability to provide administrative and operational support.
• Knowledge of payer policies and guidelines.
• Experience developing and maintaining reference materials.

Nice To Haves

• Experience with Behavioral Health Technician (BHT/RBT) progress notes.
• Familiarity with Behavior Consultant (BC) service notes (97151, 97155, 97156).
• Experience with ABASS services.

Responsibilities

• Review and score Behavioral Health Technician (BHT/RBT) progress notes using approved fidelity rubrics.
• Review Behavior Consultant (BC) service notes (97151, 97155, 97156) with supervisory guidance.
• Ensure all documentation meets regulatory, payer, and organizational standards.
• Identify documentation gaps, errors, and inconsistencies that may impact billing.
• Evaluate notes against established fidelity benchmarks and scoring criteria.
• Communicate required corrections and action items to improve documentation quality and compliance.
• Provide rubric-based feedback and recommended revisions when documentation scores fall below established thresholds (e.g., 80%).
• Accurately document and track all reviews in a timely manner.
• Monitor tracking systems to ensure timely completion and quality of progress notes.
• Support claims reviews and appeals by verifying documentation is complete and compliant.
• Partner with billing and clinical teams to resolve documentation-related denials.
• Support CR Help by updating client records, including session notes, end times, and place-of-service details.
• Audit non-billable time entries in CR to ensure accuracy.
• Coordinate insurance pre-authorizations and appeals for ABASS services by gathering required documentation, preparing submission materials, and supporting participation in the appeals process.
• Maintain a reference library of supporting literature for appeals.
• Collaborate with internal teams and payer representatives to facilitate timely resolution of authorization requests and denials.
• Maintain accurate and up-to-date data across all documentation and tracking systems.
• Provide administrative and operational support across departments, as directed.
• Support special projects and company initiatives, as assigned.
• Maintain current knowledge of payer policies and guidelines across all contracted plans.
• Develop and maintain a centralized reference of payer policies, guidelines, and updates.
• Perform additional duties as needed to support organizational operations.

What This Job Offers

• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 11-50 employees