ABA Insurance Verifications & QA Specialist · USA Hours

ISTA Personnel Solutions is a dynamic and fast-growing BPO company. We are not a recruitment agency. We partner with international US clients and integrate our staff members directly within our clients' operations. We focus on long-term placements where you contribute directly to the client's success.

We are partnering with a U.S.-based, out-of-network paediatric therapy centre offering ABA, occupational therapy, speech and language and related services, to recruit an ABA Insurance Verifications & QA Specialist.

This is a fully remote, back-office role for a confident, proactive and detail-focused individual who enjoys thinking on their feet and keeping things accurate. You will support a small in-office team by verifying out-of-network insurance benefits, managing authorisations and reviewing session notes. The role is not staff-facing at first, but the client would like to grow it into staff-facing work once you have settled in.

PLEASE NOTE:

• Working hours: Monday to Friday, 16:00–01:00 SAST (subject to US daylight saving changes)
• Public Holidays: You will be required to work on both South African and U.S. public holidays (compensation for SA public holidays in accordance with the BCEA).
• Internet Requirements: A fixed fibre line with a minimum speed of 25 Mbps (upload & download) and the ability to support a wired Ethernet connection is mandatory. Applicants without a fixed fibre line cannot be considered.
• Power Backup: A reliable power backup solution is required to manage load shedding and power outages. Applicants without a power backup cannot be considered.
• Work Environment: This is a fully remote working role and you must be based in South Africa.

Job Responsibilities (but not limited to):

• Pick up benefit checks from the Monday.com board for new enquiries and existing clients who change insurance
• Call US insurers to verify out-of-network benefits across all services, including coverage or exclusions, visit limits, deductibles, co-insurance and maximum out-of-pocket
• Record benefits accurately on the board
• Send patient responsibility contracts to parents once the payment plan has been agreed, and follow up until they are signed and returned
• Load real or placeholder authorisations into CentralReach so therapists can bill
• Extend or renew all authorisations before January, then re-verify every client’s benefits in the first two weeks of January when most plans reset
• Review flagged session notes in CentralReach and NoteGuard AI
• Check that amendment notes have been signed, then clear the label so sessions can move to payroll
• Resolve rule flags internally where possible (for example, data entered on the wrong day) and escalate to therapists where needed
• Over time, support authorisation utilisation checks, timesheet authorisation issues and follow-up on unconverted timesheets

Requirements

• ABA industry experience, with a solid understanding of the terminology (timesheets, goals, session notes, QA and authorisations). This does not need to be in billing or QA - ABA recruiting, onboarding or admin experience is sufficient
• Comfortable speaking with US insurers via telecom
• Proficiency in Microsoft 365, including Outlook and Excel
• Excellent written and spoken English
• Strong attention to detail and accuracy
• The initiative to question anything that looks off, rather than simply following the workflow
• The habit of communicating fully and proactively, giving real updates rather than one-word answers
• A confident, personable manner and an easy way of working with others

Beneficial Experience

• CentralReach experience
• Monday.com experience
• US health insurance or benefits verification experience, ideally across ABA, OT and speech
• Experience working with US or international clients
• Creative thinker, takes initiative, discusses ideas, asks questions and communicates effectively
• Friendly, pleasant and forthcoming personality

If you are not contacted within 14 working days, please consider your application unsuccessful.

Originally posted on Himalayas