Behavioral Health Compliance Auditor

4004 Aetna Medicaid Administrators; Kenner (LA); On-site; USD 54,000 - 117,000; Full time

Job summary

CVS Health is seeking a Behavioral Health Auditor in Louisiana to review medical and behavioral health records for regulatory and contractual compliance. The role involves auditing provider records, identifying coding and documentation deficiencies, and supporting corrective actions and FWA prevention efforts.

The auditor will collaborate with internal and external stakeholders, maintain professional competency, and ensure compliant audit practices across multiple regulatory requirements.

Qualifications

• Licensed Mental Health Provider in Louisiana in good standing (LPC/LMFT/LCSW/LMSW/APRN).
• Minimum of five years of professional work experience in behavioral health.
• Three to five years of experience reviewing and interpreting claims data, medical records, and clinical documentation.
• Knowledge of behavioral health documentation requirements and regulatory standards.
• Master’s degree.

Responsibilities

• Complete a variety of medical, behavioral health, and clinical audits.
• Audit provider records to ensure coding and documentation comply with regulatory standards.
• Examine treatment records to verify required documentation supports services billed.
• Develop and monitor corrective action plans for providers.
• Assist with FWA prevention, detection, and referral initiatives.
• Provide training to providers regarding regulatory requirements and documentation standards.

Job description

CVS Health is seeking a Behavioral Health Auditor in Louisiana to review medical and behavioral health records for regulatory and contractual compliance. The role involves auditing provider records, identifying coding and documentation deficiencies, and supporting corrective actions and FWA prevention efforts.

The auditor will collaborate with internal and external stakeholders, maintain professional competency, and ensure compliant audit practices across multiple regulatory requirements.