Behavioral Health Compliance & Audit Specialist

Voices for Voices; Northern (KY); Hybrid; USD 54,000 - 117,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Job summary

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

The role involves conducting provider audits, identifying deficiencies, and guiding corrective actions while collaborating with internal and external stakeholders to ensure quality and compliance across multiple lines of business in Louisiana.

Qualifications

• Licensed Mental Health Provider in Louisiana in good standing.
• Minimum of five years of professional work experience in behavioral health.
• 3–5 years reviewing and interpreting claims data and medical records.
• Knowledge of behavioral health documentation requirements and regulatory standards.
• Proficiency with digital systems and technology applications.
• Ability to travel up to 25% within Louisiana and work 8:00 a.m.–5:00 p.m. CT.
• Certification in CPC/CCS/CPMA or willingness to obtain.

Responsibilities

• Complete a variety of medical and behavioral health audits.
• Audit provider records for regulatory and contractual compliance.
• Identify coding/documentation deficiencies and document findings.
• Assist with corrective action plans and provider education.
• Support FWA prevention, detection, and referral initiatives.
• Maintain audit records and participate in reliability activities.
• Provide training and technical assistance to providers on regulations and documentation.

Skills

Communication skills

Regulatory knowledge

Analytical skills

Digital systems proficiency

Education

Master's degree

State licensure as Mental Health Provider (LPC/LMFT/LCSW/LMSW/APRN)

Job description

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

The role involves conducting provider audits, identifying deficiencies, and guiding corrective actions while collaborating with internal and external stakeholders to ensure quality and compliance across multiple lines of business in Louisiana.