RN Clinical Auditor - Behavioral Health

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
  

Requirements

• 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