Why this role stands out
This fully remote RN Clinical Auditor role offers a significant opportunity to leverage your behavioral health expertise in ensuring quality care and compliance for a reputable organization. You'll gain valuable experience in auditing and regulatory review, making this an ideal position for a detail-oriented RN who thrives on making a positive impact within healthcare. Apply today to advance your career in a flexible, remote setting.
Quick overview
Job description
- 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
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