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RN Clinical Auditor - Behavioral Health

Remote • Posted 30+ days ago • Updated 9 days ago

Contract W2

1 Year

Occasional Travel Required

Remote

Depends on Experience

Fitment

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Job Details

Skills

Auditing
Documentation
Billing
ICD-10
Medical Records
Quality Audit
VLOOKUP
Health Care
Microsoft Excel
Medicaid
Medical record audits
Chart Review
Medicaid Claims

Summary

RN Clinical Auditor - Behavioral Health

Location: Fully Remote, with occasional travel to Downtown Indianapolis, IN (expenses covered)

Job Summary:

We are seeking a Registered Nurse Clinical Auditor with extensive Behavioral Health experience to support medical record reviews and billing compliance audits for the Indiana Health Coverage Programs (IHCP). This role evaluates quality of care, reviews medical records and program policies, identifies compliance issues, prepares audit documentation and reports, and supports appeals activities within behavioral health, psychiatric, and substance use disorder treatment settings.

Key Responsibilities:

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

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

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.

Dice Id: 91133125
Position Id: 9089867
Posted 30+ days ago

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