Licensed Behavioral Health Investigator

Job Summary

A company is looking for a Clinical Investigator in Behavioral Health.

Key Responsibilities

• Conduct comprehensive reviews of medical records and documents supporting claims related to behavioral health care
• Investigate and analyze provider billing patterns to identify potential fraud, waste, and abuse
• Prepare summaries of findings and recommend preventative measures to improve internal policies and provider practices

Required Qualifications

• Master's Degree and 2 years of relevant experience required
• 2+ years of clinical experience with an independent license required
• 2 years of experience in fraud, waste, and abuse investigation required
• Behavioral health license (e.g., LMHC, LCSW, LMFT, LPC, LMHP, LIMHP) required
• Coding certification preferred