Behavioral Health Quality Analyst

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

📋 Description

• Evaluate the accuracy and consistency of the work and classifications performed by Behavioral Health auditors.

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

• Confirm findings and non-findings against medical records and relevant guidelines.

• Perform root cause analyses regarding errors, quality trends, and missed opportunities.

• Provide mentorship to Behavioral Health auditors and deliver timely, constructive feedback.

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

• Identify and report potential recovery opportunities beyond the defined audit concepts.

• Suggest process enhancements for quality, consistency, documentation standards, and overall performance.

• Communicate quality outcomes, trends, concerns, and suggestions to colleagues and management.

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

⛳️ Requirements

• At least 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.

• Comprehensive knowledge of Behavioral Health coding, billing, clinical documentation, payer requirements, and relevant regulatory guidance.

• Prior experience in conducting retrospective Behavioral Health audits to detect overpayments is preferred.

• Experience in performing quality reviews, secondary reviews, peer reviews, or audit validation for coding or clinical audit teams is preferred.

• Proven ability to identify quality trends, conduct root cause analyses, and recommend corrective actions.

• Experience in mentoring auditors and providing feedback based on quality review outcomes is preferred.

• Capacity to review Behavioral Health medical records and assess the accuracy, completeness, and support of audit findings.

• Knowledge of Behavioral Health coding, billing, modifier application, documentation requirements, payer policies, Medicare, and NCCI guidelines.

• Proficiency in drafting clear, professional audit notes utilizing Official Coding Guidelines, the ICD-10 Coding Handbook, Coding Clinic, payer policies, and other relevant references.

• Ability to mentor auditors and provide instruction through quality reviews and audit feedback.

• Advanced skills in Behavioral Health auditing and quality monitoring.

• Strong technical aptitude with the ability to quickly learn new systems.

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

• Capability to work independently as well as collaboratively within a team environment.

• Ability to complete tasks efficiently while meeting deadlines.

🏝️ Benefits

• Flexible remote work options.

• Up to 10% annual travel for team meetings and limited client on-site engagements.

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

• A collaborative culture that values ideas and insights.

• Genuine opportunities for career advancement.

• A fast-paced, innovative work environment.

• The chance to make a significant impact on healthcare delivery nationwide.