Billing Lead (Healthcare Operations / ABA RCM) - A202 at Pearl

Cape Town, Western Cape, South Africa -

Full Time

Start Date

Immediate

Expiry Date

05 Mar, 26

Salary

0.0

Posted On

05 Dec, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

ABA Medical Billing, Revenue Cycle Management, CPT Coding, Denials Management, Payer Communication, Operational Leadership, Process Optimization, Collaboration, Attention to Detail, Documentation Discipline, High-Volume Billing, Eligibility Verification, Authorization Management, Data Analysis, Team Management, SOP Development

Industry

Staffing and Recruiting

Description

Industry Healthcare Operations / Revenue Cycle Management (RCM) Work Arrangement Remote Job Type Full-time Work Schedule Monday–Friday, 9:00 AM – 5:00 PM Eastern Standard Time (EST) Locations: LATAM (Brazil, Colombia, Mexico, Argentina) Philippines Other remote regions with strong English communication and role-relevant experience About Pearl Talent Pearl works with the top 1% of candidates from around the world and connects them with the best startups in the US and EU. Our clients have raised over $5B in aggregate and are backed by companies like OpenAI, a16z, and Founders Fund. They’re looking for the sharpest, hungriest candidates who they can consistently promote and work with over many years. Candidates we’ve hired have been flown out to the US and EU to work with their clients, and even promoted to roles that match folks onshore in the US. Hear why we exist, what we believe in, and who we’re building for: WATCH HERE Why Work with Us? At Pearl, we’re not just another recruiting firm—we connect you with exceptional opportunities to work alongside visionary US and EU founders. Our focus is on placing you in roles where you can grow, be challenged, and build long-term, meaningful careers. About the Company Our client is a rapidly growing healthcare operations company that supports behavioral health and ABA organizations with end-to-end revenue cycle management. They build scalable, technology-driven systems that streamline billing, improve cash flow predictability, and help provider groups deliver high-quality patient care without administrative bottlenecks. Role Overview The Billing Lead is responsible for owning the full revenue cycle for ABA providers, including eligibility, authorizations, clean claims, denials resolution, payer communication, posting, and reconciliation. This role plays a critical part in ensuring timely payouts, accurate billing workflows, and operational visibility across the organization. The work requires a blend of hands-on RCM execution, process optimization, and cross-functional collaboration with Intake, Scheduling, Payroll, Product, and operational teams. The ideal candidate thrives in a fast-paced, scaling environment and brings deep ABA billing expertise, technical accuracy, and strong operational leadership. Your Impact You will ensure predictable and timely revenue recognition across multiple ABA provider groups. Your expertise will directly drive clean claims submission, reduce denial rates, accelerate cash collection timelines, and strengthen payer relationships. You will enhance internal billing infrastructure, streamline workflows, and influence improvements in tooling, automation, and reporting. Your leadership will help establish scalable systems that support growth, operational efficiency, and consistent financial performance for partner clinics. Core ResponsibilitiesRevenue Cycle Operations Oversee end-to-end billing for all credentialed ABA providers and clinics. Review and submit clean claims across Medicaid, commercial, and Tricare plans. Ensure accurate charge capture aligned with session logs, EVV data, and authorizations. Monitor clearinghouse rejections and correct errors within 24–48 hours. Manage denials, appeals, adjudications, and ongoing payer follow-up. Post EOBs/ERAs and reconcile deposits consistently and accurately. Authorizations & Eligibility Oversee benefit checks, eligibility verification, and VOB workflows. Manage initial and ongoing prior authorizations for all clients. Track expiring authorizations and coordinate renewals with BCBAs and Intake teams. Ensure alignment between authorization limits, units, and billing operations. Compliance & Coding Maintain payer-specific rules across Medicaid, commercial, and Tricare. Ensure CPT coding accuracy (97151, 97153, 97155, 97156), modifiers, and documentation compliance. Collaborate with Product to resolve rule gaps and support billing automation improvements. Leadership & Collaboration Build, mentor, and manage billing specialists as the function scales. Develop SOPs, QA workflows, billing playbooks, and training materials. Partner with operational teams on claim statuses, blockers, and expectations. Work with Product/Engineering to enhance billing, posting, COB, and analytics tools. Reporting & Analytics Maintain dashboards covering cash collected, AR aging, denials, and claim status. Identify trends, risk areas, and payer behavior changes. Provide leadership visibility into revenue cycle health and performance metrics. Must-Haves (Required) 3–5+ years of ABA medical billing or RCM experience. Deep understanding of ABA coding, modifiers, EVV, Medicaid rules, and authorization workflows. Experience supporting high-volume billing operations (20+ providers). Excellent written communication and documentation discipline. Ability to collaborate with engineering/design teams on tooling improvements. High attention to detail, accuracy, and operational follow-through. Ability to thrive in a fast-paced, scaling startup environment. Nice-to-Haves (Preferred) Experience with MSO structures or group NPI models. Background scaling RCM operations or leading billing teams. Familiarity with CO Medicaid, TX Medicaid, Tricare West, and multi-state commercial plans. Tools ProficiencyMust-Haves (Required) Candid Availity CO Medicaid InterChange / Gainwell TX Medicaid TMHP Tricare West (PGBA) Payspan Clearinghouses ERA/EOB posting tools Timekeeping / EVV-integrated systems Internal RCM tracking dashboards Nice-to-Haves (Preferred) Zelis UHC Provider Express Cigna/Evernorth portals Aetna Medicaid portals Optum provider tools Competitive Salary: Based on experience and portfolio quality Remote Work: Fully remote—work from anywhere Performance-Based Bonus: Based on creative quality and timely project delivery Creative Growth: Long-term opportunity to lead major campaigns or projects Generous PTO: In accordance with company policy Health Coverage for Philippines-based talents: HMO coverage after 3 months for full-time employees Direct Mentorship: Guidance from international industry experts Learning & Development: Ongoing access to resources for professional growth Our Recruitment Process Application Screening Top-Grading Interview Skills Assessment (1 internal, 2 from the client) Client Interview Job Offer Client Onboarding Ready to Join Us? If you’re a passionate storyteller with a sharp eye for detail and a love for crafting visual experiences that connect, we’d love to see your work. Apply now and take your editing career to the next level — creating content that inspires, informs, and captivates.

Responsibilities

The Billing Lead oversees the entire revenue cycle for ABA providers, ensuring timely payouts and accurate billing workflows. This role involves managing claims, denials, authorizations, and collaborating with various operational teams.