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. 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).
Numbers & Facts
Location
Indianapolis, IN (Remote)
Description
This is a remote position.
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, InterQual, or MCG guidelines for behavioral health level-of-care determinations