Behavioral Health Investigator (MO Licensed)
Job Summary
Conducting comprehensive reviews of medical records and claims, the full-time remote Behavioral Health Investigator (MO Licensed) will support the Special Investigations Unit by identifying potential overpayments and suspected healthcare fraud while ensuring compliance with coding and billing regulations.
Key responsibilities
- Perform retrospective and prepayment reviews of medical records to identify fraud, waste, and abuse
- Investigate and analyze provider billing patterns to ensure compliance with medical records and regulatory guidelines
- Prepare summaries of findings and recommend preventative measures to enhance internal policies and provider practices
Required qualifications
- Master's Degree in a relevant field
- Active behavioral health license (LMHC, LCSW, LMFT, LPC, LMHP, LIMHP)
- Minimum of 2 years of clinical experience with an independent license
- 2 years of experience in fraud, waste, and abuse investigations
- Preferred experience in provider education and managed care organizations; coding certification is a plus
Complete Job Description
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