Job Description
Join BruntWork as a Senior ABA Credentialing & Authorization Specialist and play a pivotal role in supporting US healthcare payer operations from the comfort of your home in Metro Manila. You will own end-to-end payer workflows, including provider enrollment, verification of benefits (VOBs), and authorization management, ensuring accurate data, timely submissions, and compliance that safeguard revenue for our clients.
In this role, you will collaborate with care teams, billing partners, and insurance payers to secure enrollment, verify coverage, and obtain necessary authorizations for Applied Behavior Analysis (ABA) services. You will leverage your knowledge of payer policies, credentialing standards, and healthcare regulations to drive clean claims, reduce denials, and optimize cash flow. This is a remote, full-time opportunity designed for self-motivated professionals who excel in a fast-paced environment.
Responsibilities
- Manage full-cycle provider enrollment with US payers, including initial enrollment, re-credentialing, updates, and terminations.
- Process verifications of benefits (VOBs) and prior authorization requests for ABA services in accordance with payer requirements.
- Ensure data accuracy and integrity across enrollment systems and provider profiles.
- Monitor and resolve enrollment issues, denials, and eligibility discrepancies in collaboration with internal teams.
- Maintain expert knowledge of payer policies, guidelines, and compliance requirements (HIPAA and industry standards).
- Collaborate with Billing, Compliance, and Provider Relations to improve enrollment timelines and reduce denial rates.
- Track performance against service-level agreements (SLAs) and generate regular reports on key metrics.
- Identify and implement process improvements to optimize revenue cycle efficiency and accuracy.
Qualifications
- Bachelor's degree in Healthcare Administration, Life Sciences, or a related field; equivalent professional experience considered.
- 3+ years of experience in ABA credentialing, payer enrollment, or healthcare authorization.
- Strong knowledge of US payer policies, Medicare/Medicaid, and private insurers, with focus on ABA services.
- Experience with credentialing databases and enrollment systems; proficient with MS Excel and data management tools.
- Excellent attention to detail, analytical thinking, and problem-solving abilities.
- Effective written and spoken communication; ability to work independently in a remote, deadline-driven environment.
- HIPAA-compliant practices and a solid understanding of data privacy.
- Proactive, collaborative mindset with the ability to manage multiple priorities and meet deadlines.