• In-Office Position (Monday-Friday) 8:30AM-5:00PM

• 675 Cliffside Dr. San Dimas, CA (No Remote Work Available, must be located in California)

• Work with and support providers to completely update their CAQH, NPI profiles in preparation for enrollment.
• Maintain provider credentialing files up to date.
• Review & validate provider rosters and directory listings on their payer portals.
• Follow up with insurances to ensure submissions have been accurately processed.
• Enroll with new insurances as requested by management.
• Ensure the facility and staff members are maintaining compliance with regulatory and accrediting institutions.

• Confirm client eligibility and verify insurance benefits for clinical services.
• Review and audit appointments for accuracy.
• Coordinate claims submission using billing software Central Reach.
• Process A/R Aging Reports.
• Audit and process outstanding claims within standard billing cycle.
• Verify insurance payments for accuracy and compliance.
• Billing secondary insurances (if applicable).
• Software updates including but not limited to contract rates.
• Generate revenue by meeting billing needs and insurance payout requirements to assist with development of company finances.
• Search each billing statement on Central Reach for any payment inconsistencies or errors.
• Checking each insurance payment for accuracy and compliance with insurance contracts.
• Calling insurance companies regarding any discrepancy in payments if necessary.
• Update monthly revenue spreadsheets, and run collection reports based on insurance payout reports.
• Preferred knowledge of ABA Billing Codes.

• Obtain prior authorization information in accordance with established guidelines.
• Verify prior authorizations and/or pre-service requirements are met.
• Timely completion for all current authorization requests.
• Proactively manages and maintains all authorization requests to ensure billing of claims.
• Preparing, reviewing, and transmitting claims using billing software, Central Reach, including electronic and paper claim processing.
• Maintaining patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

• Must have prior experience with credentialing and working with insurance providers.
• Knowledge in ABA Billing Codes, Practices and Procedures preferred.
• Must have prior experience with obtaining referrals, insurance authorizations.
• Solid understanding of billing software and electronic medical records.
• Must have prior experience working with various types of health insurances such as MHN and Anthem.
• Must be familiar with data collection softwares and verifying EOB's for authorized medical plans.
• Must have the ability to multitask and manage time effectively.
• Excellent written and verbal communication skills.
• Outstanding problem-solving and organizational abilities.

• A Bachelor’s degree in business, health care administration, accounting or related field is preferred.
• Insurance Billing Certification preferred but not required.
• Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems.
• A minimum of one to three years of experience as an insurance biller in a medical office setting.

Positive Behavior Steps was established in an effort to increase the amount of support to the special needs' population, as individuals with Autism and other developmental disabilities are often limited to resources that support them in overcoming barriers at home and within their community. We advocate for our clients by providing quality support with trained staff, and by assisting families that may be overwhelmed by the challenges of raising a child with developmental delays.