Behavioral Health Audit & Compliance Specialist

CVS Health Corporation; Louisiana; Hybride; USD 54 000 - 117 000; Plein temps

Avantages offerts par ce poste

Comprehensive benefits

Bonus eligibility

Résumé du poste

CVS Health Corporation in Louisiana is seeking a Behavioral Health Auditor to review medical and behavioral health records for coding and documentation compliance with state, federal, and regulatory standards.

The role requires conducting provider audits, identifying deficiencies, and recommending follow-up actions such as education, corrective action plans, and referrals for suspected fraud, waste, and abuse. Strong clinical, auditing, and communication skills are essential.

Qualifications

• Licensed Mental Health Provider in Louisiana, in good standing.
• 5 years of professional work experience, including behavioral health.
• 3–5 years reviewing and interpreting claims data, medical records, and clinical documentation.
• Knowledge of behavioral health documentation requirements and regulatory standards.
• Knowledge of medical terminology and healthcare documentation standards.
• Strong problem-solving and decision-making skills.
• Proficiency with digital systems and technology applications.
• Ability to interpret and analyze clinical, claims, and audit data.
• Ability to communicate effectively with providers, members, customers and partners.
• Must reside in Louisiana.
• Willingness to travel up to 25% within Louisiana.
• Must possess or be willing to obtain CPC, CCS, or CPMA certification.

Responsabilités

• Complete medical, behavioral health, and clinical audits.
• Audit provider records to ensure coding and documentation compliance.
• Examine treatment records to verify documentation supports billed services.
• Audit use of procedure codes, modifiers, places of service, and documentation.
• Assist with corrective action plans for providers.
• Enter data and maintain audit records with designated tools.
• Participate in inter-rater reliability activities and scoring guidelines.
• Assist with FWA prevention, detection, and referral initiatives.
• Support regulatory deliverables through timely audits and reporting.
• Provide training to providers on regulatory requirements and documentation standards.
• Maintain professional licensure and adhere to licensing board requirements.

Connaissances

Regulatory knowledge

Analytical skills

Communication skills

Problem solving

Data interpretation

Auditing experience

Formation

Master's degree

Outils

Quickbase

Description du poste

CVS Health Corporation in Louisiana is seeking a Behavioral Health Auditor to review medical and behavioral health records for coding and documentation compliance with state, federal, and regulatory standards.

The role requires conducting provider audits, identifying deficiencies, and recommending follow-up actions such as education, corrective action plans, and referrals for suspected fraud, waste, and abuse. Strong clinical, auditing, and communication skills are essential.