[Hiring] RCM Denials & Payor Compliance Specialist @Academy ABA

Remote, USA • Full-time • Posted 2026-05-31

Role Description

The RCM Denials & Payor Compliance Specialist is responsible for resolving upheld and complex billing denials, strengthening internal billing processes, and ensuring alignment with payor guidelines. This role serves as a key partner to the RCM Director in improving collections performance, reducing denial trends, and maintaining compliance with all billing and payor requirements.

Denial Resolution (Primary Focus)
Investigate and resolve upheld and complex claim denials across all payors
Perform root cause analysis to identify trends and recurring denial drivers
Develop and submit appeals, reconsiderations, and supporting documentation
Collaborate with clinical, intake, and billing teams to obtain necessary information for resolution
Maintain tracking of high-dollar and aged denial cases through resolution
Payor Guidelines & Compliance
Act as subject matter expert on payor billing rules, authorization requirements, and documentation standards
Interpret and communicate payor policies to internal teams (billing, clinical, intake)
Monitor updates to payor requirements and ensure timely internal implementation
Support audits and ensure compliance with Medicaid and commercial payor regulations
Process Development & Optimization
Identify gaps in current billing and collections workflows contributing to denials
Design and implement standardized processes to improve clean claim rates
Develop SOPs and internal guidance for billing best practices
Partner with RCM Director to transition and strengthen in-house billing operations
Cross-Functional Collaboration
Work closely with Clinical Directors, BCBAs, and Intake to resolve documentation or authorization-related denials
Provide feedback loops to prevent future denials (e.g., documentation errors, credentialing issues)
Support training initiatives for staff on billing compliance and documentation expectations
Reporting & Insights
Track and report on denial trends, resolution timelines, and financial impact
Identify opportunities to improve reimbursement and reduce revenue leakage
Provide regular updates to RCM Director on high-priority issues and risks

3+ years of experience in healthcare revenue cycle management, preferably in ABA or behavioral health
Strong experience with denial management, appeals, and payor communications
Knowledge of Medicaid and commercial insurance billing requirements
Familiarity with CPT codes relevant to ABA services (e.g., 97151, 97153, 97155, etc.)
Experience working with EMR systems (CentralReach preferred)
Strong analytical and problem-solving skills
Excellent written and verbal communication skills