RN Clinical Auditor - Behavioral Health

This is a remote position. RN Clinical Auditor - Behavioral Health Location: Fully Remote, with occasional travel to Downtown Indianapolis, IN (expenses covered) Job reputed company: We are seeking a Registered reputed company 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 reputed company of care, reviews medical records and program policies, identifies compliance issues, prepares audit documentation and reports, and supports appeals activities reputed company behavioral health, psychiatric, and reputed company 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 reputed company Reviewer • Identify documentation deficiencies and billing compliance issues reputed company psychiatric/BH claims • Maintain detailed workpapers documenting procedures, findings, and conclusions • Assist with audit responses and appeals as needed • Stay reputed company on Indiana reputed company behavioral health policy and regulatory updates Requirements Required Qualifications: • reputed company RN license, Indiana or compact • Extensive Behavioral Health experience (psychiatric reputed company, behavioral health hospitals, reputed company use disorder treatment, BH utilization review/claims work) • Auditing experience: medical record audits, compliance audits, chart review, or clinical/reputed company audits. • 2+ year of reputed company claims review, billing compliance, or reputed company reimbursement experience • Comfortable completing a timed reputed company proficiency assessment (sorting, filtering, VLOOKUP, conditional formatting), required by the reputed company prior to submission. Preferred Qualifications: • reputed company or CPC coding certification • Indiana reputed company (IHCP) program familiarity • Knowledge of CPT and ICD-10 coding • Experience with ASAM reputed company, InterQual, or MCG guidelines for behavioral health level-of-care determinations • Fraud, waste, and abuse (FWA) exposure Apply tot his job Apply To this Job