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.
Originally posted on Himalayas