Indiana Licensed RN Clinical Auditor

Job Summary

Seeking an Indiana Licensed RN Clinical Auditor with extensive Behavioral Health experience, the full-time remote position will manage medical record reviews and billing compliance audits for Indiana Health Coverage Programs, ensuring adherence to quality care standards and identifying compliance issues.

Key Responsibilities

• Review medical records and documentation to evaluate provider compliance with IHCP, CMS, AMA, and behavioral health-specific standards
• Conduct independent medical record and compliance reviews, providing preliminary findings to the Lead Reviewer
• Identify documentation deficiencies and billing compliance issues within psychiatric and behavioral health claims

Required Qualifications

• Active RN license, Indiana or compact
• Extensive Behavioral Health experience in psychiatric units, behavioral health hospitals, or substance use disorder treatment
• Auditing experience in medical record audits, compliance audits, or clinical/quality audits
• 2+ years of Medicaid claims review, billing compliance, or healthcare reimbursement experience
• Proficiency in Excel, including sorting, filtering, VLOOKUP, and conditional formatting