RN Clinical Auditor – Behavioral Health

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

📋 Description

• Evaluate provider adherence to IHCP, CMS, AMA, and specific behavioral health standards by reviewing medical records and documentation.

• Perform independent reviews of medical records and compliance.

• Share initial findings with the Lead Reviewer.

• Detect deficiencies in documentation and issues related to billing compliance in psychiatric and behavioral health claims.

• Keep comprehensive workpapers that detail procedures, findings, and conclusions.

• Assist with responses to audits and appeals when necessary.

• Remain updated on regulatory changes and policies concerning Indiana Medicaid behavioral health.

⛳️ Requirements

• Valid RN license in Indiana or a compact license.

• Significant experience in Behavioral Health, including work in psychiatric units, behavioral health hospitals, substance use disorder treatment, or utilization review/claims in behavioral health.

• Experience in auditing medical records, compliance, chart reviews, or clinical/quality audits.

• A minimum of 2 years' experience in Medicaid claims review, billing compliance, or healthcare reimbursement.

• Proficient in completing a timed Excel proficiency assessment that includes sorting, filtering, VLOOKUP, and conditional formatting.

• Preferred certification in CCS or CPC coding.

• Familiarity with the Indiana Medicaid (IHCP) program is preferred.

• Preferred knowledge of CPT and ICD-10 coding.

• Experience with ASAM criteria, InterQual, or MCG guidelines for determining behavioral health levels of care is preferred.

• Preferred exposure to fraud, waste, and abuse (FWA) issues.

🏝️ Benefits

• Coverage for occasional travel expenses to Downtown Indianapolis, IN.