RN Clinical Auditor Behavioral Health
Job Location:
Indianapolis, IN - USA
Monthly Salary:
Experience Required:
Posted:
Application Deadline:
Vacancies:
Job Summary
This is a remote position.
- Review medical records and documentation to evaluate provider compliance with IHCP CMS AMA and behavioral health-specific standards
- Conduct medical record and compliance reviews independently providing preliminary findings to the Lead Reviewer
- Identify documentation deficiencies and billing compliance issues within psychiatric/BH claims
- Maintain detailed workpapers documenting procedures findings and conclusions
- Assist with audit responses and appeals as needed
- Stay current on Indiana Medicaid behavioral health policy and regulatory updates
- Active RN license Indiana or compact
- Extensive Behavioral Health experience (psychiatric units behavioral health hospitals substance use disorder treatment BH utilization review/claims work)
- Auditing experience: medical record audits compliance audits chart review or clinical/quality audits.
- 2 year of Medicaid claims review billing compliance or healthcare reimbursement experience
- Comfortable completing a timed Excel proficiency assessment (sorting filtering VLOOKUP conditional formatting) required by the client prior to submission.
- CCS or CPC coding certification
- Indiana Medicaid (IHCP) program familiarity
- Knowledge of CPT and ICD-10 coding
- Experience with ASAM criteria InterQual or MCG guidelines for behavioral health level-of-care determinations
- Fraud waste and abuse (FWA) exposure
Required Skills:
Required Qualifications: Active RN license Indiana or compact Extensive Behavioral Health experience (psychiatric units behavioral health hospitals substance use disorder treatment BH utilization review/claims work) Auditing experience: medical record audits compliance audits chart review or clinical/quality audits. 2 year of Medicaid claims review billing compliance or healthcare reimbursement experience Comfortable completing a timed Excel proficiency assessment (sorting filtering VLOOKUP conditional formatting) required by the client prior to submission. Preferred Qualifications: CCS or CPC coding certification Indiana Medicaid (IHCP) program familiarity Knowledge of CPT and ICD-10 coding Experience with ASAM criteria InterQual or MCG guidelines for behavioral health level-of-care determinations Fraud waste and abuse (FWA) exposure
