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Open nowPosted 4 hours ago

ABA Insurance Verifications & QA Specialist | USA Hours | Remote

ISTA Personnel Solutions

Where
Eastern Cape, South Africa
Work mode
Remote
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Your applicationOpen nowABA Insurance Verifications & QA Specialist | USA Hours | RemoteISTA Personnel Solutions · Eastern Cape, South Africa

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  4. CV RocketApplied on ISTA Personnel Solutions's own form.

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The clock on this job

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Share of postings closed within
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  2. 4.6%3 days
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  4. 21.8%14 days
  5. 36.6%30 days
  6. 58.9%60 days
This job: posted 4 hours ago

The posting

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.

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