Licensed Behavioral Health Investigator
Job Summary
To support the Special Investigations Unit, the full-time Licensed Behavioral Health Investigator will conduct comprehensive reviews of medical records and documents to identify potential fraud, waste, and abuse in billing practices, working remotely across multiple states.
Key responsibilities
- Perform retrospective and prepayment reviews of medical records to identify inappropriate billing practices
- Investigate and analyze provider billing patterns based on medical records and regulatory guidelines
- Prepare summaries of findings and recommend preventative measures to enhance internal policies and procedures
Required qualifications
- Master's Degree and 2+ years of direct board clinical behavioral health experience with a fully independent clinical license
- 2+ years of experience in fraud, waste, and abuse investigations
- One of the following Behavioral Health licenses is required: LMHC, LCSW, LMFT, LPC, LMHP, or LIMHP
- Experience in behavioral health provider reviews and medical record analysis preferred
- Strong clinical documentation and problem-solving skills required
Complete Job Description
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