Behavioral Health Compliance & QA Specialist (30 hrs) CPC-C

Chimes International Limited; Baltimore (MD); Sur place; USD 63 000 - 77 000; Plein temps

Avantages offerts par ce poste

Health Insurance

Tuition Reimbursement

Flexible Spending Accounts

401(k) Retirement Plan

Paid Time Off

Employee Recognition

Résumé du poste

Chimes is seeking a Behavioral Health Specialist to join our Compliance team in Maryland. You’ll conduct audits, review clinical documentation for accuracy and regulatory compliance, and ensure programs meet standards while supporting individuals with intellectual and developmental disabilities.

The role emphasizes analysis, investigation, and collaboration with leadership. Requires CPC/CPC-A, 4+ years of relevant experience, and ability to travel between agency locations.

Qualifications

• Active CPC or CPC-A Medical Coding Certification.
• Minimum of four (4) years of professional experience in behavioral health, healthcare compliance, quality assurance, clinical documentation, auditing, or a related field.
• Knowledge of behavioral health documentation, regulatory requirements, and compliance practices.
• Familiarity with CPT, revenue, and diagnostic coding.
• Strong analytical, investigative, organizational, and problem-solving skills.
• Excellent written and verbal communication skills.
• Proficiency in Microsoft Office, particularly Word and Excel.
• Ability to travel between agency locations as needed.
• Ability to maintain confidentiality, manage multiple priorities, and work independently.

Responsabilités

• Conduct scheduled and unannounced audits of programs, clinical records, documentation, and compliance activities.
• Review behavioral health and clinical documentation for accuracy, completeness, and regulatory compliance.
• Monitor compliance with psychological, nursing, behavioral health, and other required clinical services.
• Assist with investigations, identify compliance concerns, and recommend corrective actions.
• Develop and monitor Plans of Correction resulting from audits, investigations, and regulatory reviews.
• Review clinical records, claims, CPT codes, and billing documentation to identify potential compliance issues.
• Evaluate applicable Medicare, Medicaid, and commercial insurance requirements.
• Prepare audit reports, compliance findings, and recommendations for leadership.
• Provide guidance and training to staff regarding documentation, regulatory requirements, and quality improvement.

Connaissances

CPC/CPC-A Certification

Excellent communication

Analytical skills

MS Office (Word/Excel)

Travel to locations

Formation

CPC or CPC-A Medical Coding Certification

Bachelor’s degree in Behavioral Health

Outils

CPT coding knowledge

Regulatory compliance tools

Description du poste

Chimes is seeking a Behavioral Health Specialist to join our Compliance team in Maryland. You’ll conduct audits, review clinical documentation for accuracy and regulatory compliance, and ensure programs meet standards while supporting individuals with intellectual and developmental disabilities.

The role emphasizes analysis, investigation, and collaboration with leadership. Requires CPC/CPC-A, 4+ years of relevant experience, and ability to travel between agency locations.