Senior Billing Coordinator

MedCare Pediatric • Stafford, TX

2d • $24 - $32

About The Position

MedCare Pediatric is seeking a highly experienced Senior Billing Coordinator to join our centralized billing team. This role is designed for an accomplished biller with 5+ years of ABA and pediatric therapy billing experience, deep knowledge of Texas Medicaid Managed Care Organizations (MCOs), and proven expertise resolving complex denials.

Requirements

• 5+ years of ABA or pediatric therapy billing experience
• Demonstrate expertise resolving Texas Medicaid MCO denials (TCHP, Superior, Amerigroup, Molina, UHC Community, CHC)
• Strong knowledge of ABA authorization structures, unit limits, and modifier requirements
• Experience billing commercial ABA carriers (Aetna, Cigna, BCBS TX, UHC, Tricare, Optum)
• EMR experience with Raintree, KanTime, WebABA strongly preferred
• Advanced attention to detail, follow-through, and compliance

Responsibilities

• Review and process ABA and therapy medical records to ensure accurate, compliant billing
• Submit claims after verifying authorizations, units, modifiers, place of service, and rendering provider details
• Lead resolution of MCO-specific denials including authorization mismatches, unit overages, timely filing, missing modifiers, credentialing issues, and medical necessity reviews
• Independently work denials and underpayments from Texas Medicaid MCOs including Texas Children’s Health Plan (TCHP), Superior HealthPlan, Amerigroup, Molina Healthcare, UnitedHealthcare Community Plan, and Community Health Choice
• Prepare and submit reconsiderations, appeals, corrected claims, and dispute packets in accordance with payer-specific timelines and requirements
• Manage commercial ABA payer denials with carriers such as Aetna, Cigna, Blue Cross Blue Shield of Texas, UnitedHealthcare, Tricare, and Optum
• Verify insurance eligibility and ABA authorization parameters (units, frequency, date ranges)
• Partner with clinicians and operations teams to correct documentation deficiencies and prevent repeat denials
• Utilize EMR platforms such as Raintree, KanTime, WebABA, or similar therapy-focused systems

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed