RN Clinical Auditor - Behavioral Health

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 Requirements 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, Inter. Qual, or MCG guidelines for behavioral health level-of-care determinations Fraud, waste, and abuse (FWA) exposure