Behavioral Health Compliance Auditor

CVS Health; United States; Remote; USD 54,000 - 117,000; Full time

Job summary

CVS Health seeks a Behavioral Health Auditor to review medical and behavioral health records for coding accuracy and regulatory compliance across Louisiana. The role requires identifying deficiencies, recommending actions, and supporting education for providers.

You will collaborate with internal and external stakeholders, maintain audit records, and contribute to quality improvement initiatives while adhering to confidentiality and licensure requirements.

Qualifications

• Licensed Mental Health Provider in Louisiana with no restrictions.
• 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 handle sensitive information ethically and responsibly.
• Ability to communicate effectively with providers and members.
• Must reside in Louisiana and travel up to 25%.

Responsibilities

• Complete a variety of medical and behavioral health audits.
• Audit provider records for regulatory compliance across Louisiana Department of Health and Office of Behavioral Health standards.
• Examine treatment records to ensure documentation supports services billed.
• Identify coding and documentation deficiencies and follow up with actions.
• Develop and monitor corrective action plans for providers.
• Maintain audit records using designated audit tools.
• Participate in inter-rater reliability activities and scoring guideline development.
• Support FWA prevention, detection, and referral initiatives.
• Provide education and training to providers on regulations and coding.
• Maintain licensure and stay current with regulatory changes.

Skills

Licensed Mental Health Provider

Behavioral health experience

Claims data review

Regulatory knowledge

Communication skills

Education

Master’s degree

Tools

Quickbase

Job description

CVS Health seeks a Behavioral Health Auditor to review medical and behavioral health records for coding accuracy and regulatory compliance across Louisiana. The role requires identifying deficiencies, recommending actions, and supporting education for providers.

You will collaborate with internal and external stakeholders, maintain audit records, and contribute to quality improvement initiatives while adhering to confidentiality and licensure requirements.