Calpion - ABA Billing Business Analyst

Description :

Position Title : ABA Billing Business Analyst

Location : Bangalore

Experience : 3+ years in ABA Billing / RCM

Position Overview :

We are seeking an experienced Business Analyst with strong expertise in ABA therapy billing and Revenue Cycle Management (RCM). The candidate will work on the Artemis platform to optimize billing workflows, improve compliance, and drive revenue growth for ABA therapy organizations.

Key Responsibilities :

1. Billing Operations & Analysis :

- Analyze and optimize ABA billing workflows including authorization tracking, claims submission, and payment posting

- Identify revenue leakage points and implement corrective actions

- Develop billing performance metrics and KPI dashboards

- Conduct root-cause analysis for claim denials and rejections

- Create and maintain billing process documentation

2. Requirements Gathering & System Enhancements :

- Gather and document billing requirements from stakeholders (billers, RCM managers, clinical teams)

- Translate business needs into functional specifications for the development team

- Design billing automation solutions to reduce manual work

- Define acceptance criteria and prepare test scenarios for billing features

3. Compliance & Payer Management :

- Ensure compliance with Medicaid, Medicare, and commercial payer guidelines

- Stay updated on ABA-specific CPT codes : 97151, 97152, 97153, 97155, 97156, etc.

- Understand state-specific ABA coverage rules and limitations

- Support audit preparation and payer reconciliation activities

4. Data Analysis & Reporting :

- Analyze claims data to identify trends, bottlenecks, and improvement areas

- Generate reports for AR aging, collection rates, denial rates, and revenue metrics

- Assist in financial forecasting and revenue projections

- Conduct comparative analysis across payers and service categories

Required Qualifications :

ABA Billing Expertise :

- Minimum 3+ years of experience in ABA therapy billing or RCM

- Strong understanding of ABA CPT codes

- Knowledge of authorization processes & managed care workflows

- Experience with Medicaid billing (state-specific knowledge preferred)

- Familiarity with commercial insurance billing for ABA services

Business Analysis Skills :

- Proven experience gathering and documenting business requirements

- Strong analytical and problem solving abilities

- Experience creating process flows, user stories, and functional specs

- Ability to work collaboratively with clinical, billing, and technical teams

Technical Competencies :

- Proficiency in Excel/Google Sheets (Pivot tables, VLOOKUP, formulas)

- Experience using billing systems or practice management platforms

- SQL knowledge (preferred)

- Familiarity with Salesforce or similar CRM systems (preferred)

Soft Skills :

- Excellent verbal and written communication skills

- Strong attention to detail and organizational skills

- Ability to work independently in a remote/distributed setup

- Strong stakeholder collaboration and coordination skills

Preferred Qualifications :

- Experience with ChargeBee, Salesforce Health Cloud, or similar tools

- Knowledge of HIPAA compliance rules

- Understanding of ERA/835 file processing

- Experience in Power BI or other analytics platforms

- Background in healthcare RCM consulting or process optimization