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Insurance Auditor Bcba Jobs in California (NOW HIRING)

Onos

Clinical Quality Reviewer - BCBA

San Francisco, CA · On-site

$110K - $140K/yr

Experience auditing clinical documentation and charts for quality and compliance * Strong written ... Medical, dental, and vision insurance * Pre-tax commuter benefits * 401(k) * Significant equity as ...

Essc

Clinical Case Manager

Los Angeles, CA · On-site

... auditing subcontracted vendors and monitoring development of children diagnosed on the Autism ... Must be a Board-Certified Behavior Analyst (BCBA); Marriage Family Therapist (MFT) or licensed ...

Essc

Clinical Case Mgr

Gardena, CA

... auditing subcontracted vendors and monitoring development of children diagnosed on the Autism ... Must be a Board-Certified Behavior Analyst (BCBA); Marriage Family Therapist (MFT) or licensed ...

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Insurance Auditor Bcba information

What is an insurance auditor BCBA?

An Insurance Auditor BCBA is a Board Certified Behavior Analyst who specializes in auditing clinical documentation and billing practices for insurance compliance. They review treatment plans, progress notes, and submitted claims to ensure that services provided by behavior analysts meet insurance standards and regulations. Their role helps prevent fraudulent billing, improves quality assurance, and ensures that clients receive appropriate and authorized care. Insurance Auditor BCBAs often work for insurance companies or as independent consultants, and they must have a deep understanding of both applied behavior analysis and insurance policies.

How does an insurance auditor BCBA typically collaborate with clinical teams and insurance providers to ensure compliance and accurate billing?

An Insurance Auditor BCBA works closely with both clinical teams and insurance providers to review treatment plans, verify service documentation, and ensure billing practices align with regulatory and payer requirements. This role often involves conducting internal audits, providing feedback to clinicians on documentation standards, and serving as a liaison during insurance reviews or audits. Successful collaboration requires clear communication, up-to-date knowledge of industry guidelines, and attention to detail to prevent claim denials and support ethical service delivery.

What are the key skills and qualifications needed to thrive as an insurance auditor BCBA, and why are they important?

To excel as an Insurance Auditor BCBA, you need a deep understanding of applied behavior analysis (ABA), strong analytical skills, and certification as a Board Certified Behavior Analyst (BCBA). Familiarity with insurance billing systems, coding practices (such as CPT codes), and compliance documentation is essential. Attention to detail, integrity, and effective communication are crucial soft skills for reviewing claims and collaborating with providers. These competencies ensure accurate audits, minimize fraud, and support regulatory compliance within the behavioral health insurance sector.

What is the difference between Insurance Auditor Bcba vs Insurance Claims Adjuster?

AspectInsurance Auditor BcbaInsurance Claims Adjuster
Required CredentialsBCBA certification, relevant insurance auditing experienceAdjuster license, insurance knowledge
Work EnvironmentHealthcare, insurance companies, auditing settingsInsurance companies, claims departments, field or office
Industry UsageUsed mainly in health insurance and behavioral health sectorsUsed across various insurance lines including health, auto, property

Insurance Auditor Bcba and Insurance Claims Adjuster roles both involve evaluating insurance claims, but the Auditor Bcba focuses on behavioral health and insurance compliance, requiring BCBA credentials. In contrast, Claims Adjusters handle a broader range of insurance claims across multiple lines, often needing an adjuster license. While both work within the insurance industry, their specific environments and expertise areas differ significantly.

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Insurance Auditor Bcba jobs near you

Clinical Quality Reviewer - BCBA

Onos

San Francisco, CA • On-site

$110K - $140K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 26 days ago

Job description

Clinical Quality Reviewer - BCBA
About Onos Health
Onos Health's mission is simple but ambitious: ensure every healthcare dollar goes toward delivering the highest quality care. Today, nearly 30% of U.S. healthcare spending is wasted due to ineffective care and administrative burden, driven by misalignment between providers and payers. This waste is a primary reason healthcare remains unaffordable for so many.
Onos is addressing this by building the largest AI-driven healthcare data platform for clinical decision-making. Onos' models help health plans make faster, more accurate decisions across their populations. The result is less friction between plans, providers, and members, better outcomes, and more affordable care.
Why Onos?
  • Meaningful impact: Help fix what is fundamentally broken in healthcare
  • Direct collaboration: Work alongside experienced founders with deep healthcare and data expertise
  • Culture: Join a high-performing, transparent, and results-oriented team
  • Ownership: Significant responsibility and autonomy from day one
  • Opportunity: Play a pivotal role in building a fast-growing, category-defining healthcare AI company

The role:
At Onos, we partner with payers to help improve outcomes, ensure high quality of care for every member and reduce provider friction. We are seeking a Board Certified Behavior Analyst (BCBA) with deep clinical expertise to support in solving these needs and refining our models and product. This role offers the opportunity to help shape innovative technology solutions designed to improve quality specifically in autism/ABA services.
In this role, you'll report directly to our Senior Vice President of Clinical Operations and work alongside the clinical and product teams to validate system outputs, support enhancements, and make modifications to our platform.
The ideal candidate is detail-oriented with strong applied clinical knowledge and an interest in improving outcomes in autism/ABA services, enabling data-driven decision making, developing operational efficiencies, and AI-enabled healthcare solutions.
What you'll own:
  • Review ABA treatment plans and supporting clinical documentation for medical necessity and clinical appropriateness and compare platform-generated outputs, analyses, and recommendations against independent clinical review findings.
  • Identify discrepancies, edge cases, or workflow gaps and provide structured feedback to support ongoing platform refinement
  • Collaborate cross-functionally with clinical, product, engineering, and account management teams to help improve the product to ensure stellar customer experience
  • Participate in calibration and inter-rater reliability activities to ensure consistency
  • Assist in development and refinement of quality assurance and improvement methodologies, audit tools, and outcome metrics
  • Perform other data validation tasks as needed
  • Maintain accurate and timely documentation of findings and recommendations

What we're looking for:
  • Current BCBA certification in good standing
  • Minimum 2-3 years of experience in ABA utilization management, clinical supervision, quality assurance/improvement (specific to ABA/autism services) or in an equivalent ABA leadership role
  • Experience reviewing ABA treatment plans and assessing clinical justification for recommended services
  • Knowledge of commonly used assessment tools and scoring in ABA
  • Strong understanding of medical necessity criteria and general payer expectations related to ABA services
  • Experience auditing clinical documentation and charts for quality and compliance
  • Strong written communication and analytical skills
  • Exceptional attention to detail and organizational skills
  • Ability to work independently in a fast-paced environment

Nice to have's:
  • Experience in utilization management, care review, or prior authorization review for a payer or managed care organization
  • Experience with quality metrics/outcomes data
  • Familiarity with multiple ABA payer guidelines, authorization processes, and documentation standards
  • Experience using EHRs and clinical review platforms
  • Experience analyzing claims, utilization, or outcomes data

Location:
  • Based in the San Francisco Bay Area and willing to work in a hybrid work environment 2-3x per week

Compensation
  • $110,000-$140,000 base salary + equity

Benefits and Perks
  • Flexible hybrid arrangement: 2-3 days/week at San Francisco office (Financial District), remote-first culture
  • Unlimited vacation policy
  • Paid parental leave
  • Medical, dental, and vision insurance
  • Pre-tax commuter benefits
  • 401(k)
  • Significant equity as an early employee
  • Direct mentorship from experienced founders
  • Ground-floor opportunity to help build a team and culture
  • Regular team events and offsites
  • Company-provided equipment and home office setup

Apply