Peak Behavioral Services Inc
Billing and Credentialing specialist
Peak Behavioral Services Inc, Forest Park, Illinois, United States, 60130
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Founder & CEO of Peak Behavioral Services
Company Description Peak Behavioral Services Inc. offers a range of therapies including clinic and home-based ABA therapy, speech therapy, and occupational therapy. Position Summary The ABA Therapy Medical Biller & Credentialing Specialist is responsible for managing all aspects of the billing, reimbursement, and credentialing processes for Applied Behavior Analysis (ABA) services. This role ensures timely and accurate claims submission, payment posting, and credentialing maintenance with commercial and Medicaid payers in Illinois. The specialist will work closely with clinicians, administrative staff, and insurance representatives to maintain compliance with state and federal billing requirements, payer regulations, and HIPAA standards. Key Responsibilities
Prepare, review, and submit clean claims for ABA therapy services to commercial and Medicaid payers (e.g., BCBS IL, Aetna, Cigna, Illinois Medicaid MCOs). Verify that all CPT codes (e.g., 97151, 97153, 97155, 97156, 97158) are applied accurately according to session documentation and payer rules. Track claims throughout the billing cycle; identify, research, and resolve rejections or denials promptly. Reconcile daily payments and post to patient accounts accurately in practice management software (e.g., CentralReach, Theralytics). Generate monthly revenue reports and accounts receivable summaries for leadership. Ensure compliance with payer‑specific prior authorization and utilization management requirements. Follow up on unpaid or underpaid claims to reduce aging A/R. Manage secondary claims and coordination of benefits when applicable. Credentialing & Contract Management
Complete initial and re‑credentialing applications for BCBAs, RBTs, and organizational NPI/Group Tax ID with commercial and Medicaid payers in Illinois. Maintain and update CAQH profiles for all providers; track expiration dates for licenses, liability insurance, and certifications. Submit and monitor applications for new site enrollments and MCO paneling (e.g., Molina, Aetna Better Health, Meridian, Blue Cross Community). Communicate regularly with insurance representatives to track credentialing status and resolve delays. Maintain detailed credentialing logs and ensure organizational compliance with payer credentialing standards. Compliance & Documentation
Ensure all billing and credentialing activities comply with Illinois Department of Healthcare and Family Services (HFS) and insurance payer policies. Stay updated on CPT code changes, payer bulletins, and Medicaid behavioral health guidelines. Maintain accurate digital and paper documentation per HIPAA and company policies. Participate in audits and assist in correcting discrepancies found during internal or external reviews. Serve as the main point of contact between clinical staff, clients, and payers regarding billing or credentialing issues. Educate staff on documentation or authorization requirements that affect billing. Collaborate with the finance and operations teams to forecast revenue and ensure accurate reporting. Qualifications:
Required: High school diploma or equivalent. Preferred: Associate’s or Bachelor’s degree in Health Administration, Business, or related field. 2+ years of experience in medical billing for behavioral health or ABA therapy. 1+ year of experience with credentialing for Illinois commercial and Medicaid payers. Familiarity with CentralReach, Theralytics, or similar ABA practice management systems. Experience with Illinois Medicaid MCOs (Molina, Meridian, Aetna Better Health, Blue Cross Community). Strong knowledge of CPT and ICD‑10 coding for ABA services. Understanding of Illinois‑specific payer and Medicaid guidelines for behavioral health. Proficiency with EHR and clearinghouse systems. Excellent organizational and multitasking skills. Strong written and verbal communication. Attention to detail and ability to meet strict deadlines. Knowledge of HIPAA, PHI, and healthcare compliance regulations. Performance Indicators:
Percentage of clean claims submitted (goal: 95%+). Days in Accounts Receivable (goal:
Denial rate and resolution time. Average credentialing turnaround time. Accuracy and timeliness of reports. Competitive hourly rate or salary based on experience. Paid time off and holidays. Professional development and continuing education support. Flexible scheduling (hybrid options available). Referrals increase your chances of interviewing at Peak Behavioral Services Inc by 2x Get notified about new Billing Specialist jobs in
Forest Park, IL . Glendale Heights, IL $50,000 - $58,000 1 day ago Chicago, IL $91,800 - $132,600 2 months ago Seniority level
Entry level Employment type
Full‑time Job function
Accounting/Auditing and Finance Industries
Mental Health Care
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Company Description Peak Behavioral Services Inc. offers a range of therapies including clinic and home-based ABA therapy, speech therapy, and occupational therapy. Position Summary The ABA Therapy Medical Biller & Credentialing Specialist is responsible for managing all aspects of the billing, reimbursement, and credentialing processes for Applied Behavior Analysis (ABA) services. This role ensures timely and accurate claims submission, payment posting, and credentialing maintenance with commercial and Medicaid payers in Illinois. The specialist will work closely with clinicians, administrative staff, and insurance representatives to maintain compliance with state and federal billing requirements, payer regulations, and HIPAA standards. Key Responsibilities
Prepare, review, and submit clean claims for ABA therapy services to commercial and Medicaid payers (e.g., BCBS IL, Aetna, Cigna, Illinois Medicaid MCOs). Verify that all CPT codes (e.g., 97151, 97153, 97155, 97156, 97158) are applied accurately according to session documentation and payer rules. Track claims throughout the billing cycle; identify, research, and resolve rejections or denials promptly. Reconcile daily payments and post to patient accounts accurately in practice management software (e.g., CentralReach, Theralytics). Generate monthly revenue reports and accounts receivable summaries for leadership. Ensure compliance with payer‑specific prior authorization and utilization management requirements. Follow up on unpaid or underpaid claims to reduce aging A/R. Manage secondary claims and coordination of benefits when applicable. Credentialing & Contract Management
Complete initial and re‑credentialing applications for BCBAs, RBTs, and organizational NPI/Group Tax ID with commercial and Medicaid payers in Illinois. Maintain and update CAQH profiles for all providers; track expiration dates for licenses, liability insurance, and certifications. Submit and monitor applications for new site enrollments and MCO paneling (e.g., Molina, Aetna Better Health, Meridian, Blue Cross Community). Communicate regularly with insurance representatives to track credentialing status and resolve delays. Maintain detailed credentialing logs and ensure organizational compliance with payer credentialing standards. Compliance & Documentation
Ensure all billing and credentialing activities comply with Illinois Department of Healthcare and Family Services (HFS) and insurance payer policies. Stay updated on CPT code changes, payer bulletins, and Medicaid behavioral health guidelines. Maintain accurate digital and paper documentation per HIPAA and company policies. Participate in audits and assist in correcting discrepancies found during internal or external reviews. Serve as the main point of contact between clinical staff, clients, and payers regarding billing or credentialing issues. Educate staff on documentation or authorization requirements that affect billing. Collaborate with the finance and operations teams to forecast revenue and ensure accurate reporting. Qualifications:
Required: High school diploma or equivalent. Preferred: Associate’s or Bachelor’s degree in Health Administration, Business, or related field. 2+ years of experience in medical billing for behavioral health or ABA therapy. 1+ year of experience with credentialing for Illinois commercial and Medicaid payers. Familiarity with CentralReach, Theralytics, or similar ABA practice management systems. Experience with Illinois Medicaid MCOs (Molina, Meridian, Aetna Better Health, Blue Cross Community). Strong knowledge of CPT and ICD‑10 coding for ABA services. Understanding of Illinois‑specific payer and Medicaid guidelines for behavioral health. Proficiency with EHR and clearinghouse systems. Excellent organizational and multitasking skills. Strong written and verbal communication. Attention to detail and ability to meet strict deadlines. Knowledge of HIPAA, PHI, and healthcare compliance regulations. Performance Indicators:
Percentage of clean claims submitted (goal: 95%+). Days in Accounts Receivable (goal:
Denial rate and resolution time. Average credentialing turnaround time. Accuracy and timeliness of reports. Competitive hourly rate or salary based on experience. Paid time off and holidays. Professional development and continuing education support. Flexible scheduling (hybrid options available). Referrals increase your chances of interviewing at Peak Behavioral Services Inc by 2x Get notified about new Billing Specialist jobs in
Forest Park, IL . Glendale Heights, IL $50,000 - $58,000 1 day ago Chicago, IL $91,800 - $132,600 2 months ago Seniority level
Entry level Employment type
Full‑time Job function
Accounting/Auditing and Finance Industries
Mental Health Care
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