Medical Billing Director

Medical Billing Director

Lakewood, NJ

100,000 - $150,000

Our client is seeking an experienced and strategic Medical Billing Director to lead the billing and revenue cycle management (RCM) operations for our growing Applied Behavior Analysis (ABA) organization. This leadership role will oversee all aspects of medical billing, ensuring accurate claims processing, compliance with insurance regulations, and optimization of reimbursement for ABA therapy services. The ideal candidate will bring expertise in behavioral health billing, a deep understanding of ABA-specific CPT codes, and a proven ability to manage a team in a dynamic, client-focused environment.

Responsibilities :

• Billing Oversight : Direct the end-to-end medical billing process for ABA services, including charge capture, coding, claims submission, payment posting, and denial management, ensuring timely and accurate reimbursement.
• Revenue Cycle Management : Develop and implement strategies to optimize the revenue cycle, reduce claim denials, and improve cash flow, specifically tailored to the complexities of ABA therapy billing across multiple payers (e.g., Medicaid, private insurance).
• Compliance : Ensure all billing practices adhere to federal, state, and payer-specific regulations, including HIPAA, as well as ABA-specific guidelines (e.g., CPT codes 97151-97158, 0362T, 0373T), maintaining a high standard of ethical and legal compliance.
• Team Leadership : Manage and mentor a team of billing specialists, coders, and support staff, fostering a culture of accuracy, accountability, and continuous improvement. Conduct training on ABA billing codes, payer policies, and best practices.
• Payer Relations : Negotiate contracts with insurance providers, resolve complex billing disputes, and maintain strong relationships with payers to maximize reimbursement rates and streamline authorization processes.
• Process Optimization : Identify inefficiencies in billing workflows and implement data-driven solutions, leveraging ABA practice management software (e.g., CentralReach, Kareo) to enhance operational efficiency.
• Reporting and Analysis : Generate and analyze financial reports on billing performance, denial trends, and revenue metrics, providing actionable insights to senior leadership to support strategic decision-making.
• Pre-Billing Coordination : Oversee eligibility verification, prior authorizations, and client intake processes to ensure seamless billing from the outset of therapy services.
• Audit Preparedness : Conduct regular internal audits of billing records and prepare for external audits, ensuring documentation meets payer and regulatory standards.
• Collaboration : Partner with clinical leadership, HR, and finance teams to align billing operations with organizational goals and client care objectives.

Qualifications :

Salary : $100,000 - $150,000