Behavioral Health Quality Analyst

This is a fully remote position, open to applicants in United States.

📋 Description

• Assess the accuracy and consistency of the work performed by Behavioral Health auditors and their audit classifications.

• Conduct both random and targeted quality reviews of Behavioral Health audits.

• Validate findings and non-findings against medical record documentation and relevant guidelines.

• Carry out root cause analyses to identify errors, quality trends, and missed opportunities.

• Guide auditors and offer timely, constructive feedback.

• Review initial audits, appeals, and other assigned auditing tasks.

• Spot and escalate potential recovery opportunities.

• Suggest process enhancements to improve quality, consistency, documentation, and overall performance.

• Share quality results, trends, concerns, and recommendations with colleagues and management.

• Execute responsibilities in line with compliance, information security, and regulatory policies.

⛳️ Requirements

• A minimum of five years of experience in Behavioral Health services, encompassing mental health and substance use disorder treatment.

• One or more of the following credentials is preferred: CCS, RHIA, RHIT, CPC, Registered Nurse, or MSW.

• Strong understanding of Behavioral Health coding, billing, clinical documentation, payer requirements, and regulatory guidelines.

• Experience with retrospective Behavioral Health audits is preferred.

• Background in quality reviews, secondary reviews, peer reviews, or audit validation is preferred.

• Proficient in identifying quality trends, conducting root cause analyses, and recommending corrective actions.

• Experience in mentoring auditors and providing feedback is preferred.

• Knowledge of modifier applications, documentation requirements, payer policies, Medicare, and NCCI guidelines.

• Ability to write audit notes that are supported by Official Coding Guidelines, the ICD-10 Coding Handbook, Coding Clinic, payer policies, and other references.

• Excellent verbal and written communication abilities.

• Advanced skills in Behavioral Health auditing and quality monitoring.

• Strong technical aptitude and a quick learning capability for new systems.

• Proficiency in Microsoft Excel, PowerPoint, Outlook, and Word.

🏝️ Benefits

• 100% remote work flexibility.

• Up to 10% annual travel for team meetings and limited client onsite engagements.

• Opportunities for growth and mentorship through a structured coaching program.

• Collaborative culture where ideas and insights are valued.

• Opportunities for advancement.

• Opportunities to grow your career and expand your skills.