Chart Auditor

Wayspring; Nashville (TN); On-site; USD 70,000 - 95,000; Full time

Benefits offered by this job

Medical, Dental and Vision Insurance

HSA + Gym Allowance

Parental leave

Disability & Life Insurance

401k with company match

Employee Assistance Program

Sabbatical program

Paid holidays

Job summary

Wayspring is seeking a Chart Auditor to perform clinical chart reviews for behavioral health records, ensuring medical necessity and proper documentation. You will work with AI-assisted tools and guidance from clinical leadership to shape rubrics and policies as our reviews scale.

Ideal candidates have active medical coding certifications, several years of chart audit or utilization review experience, and comfort with new technology.

Qualifications

• Active CPC, CCS, CCS-P, CPMA, or comparable nationally recognized medical coding/auditing certification.
• 3+ years of clinical behavioral health experience and 2+ years in utilization review or chart auditing.
• Strong written communication and ability to document defensible rationale.
• Comfort with learning and using AI-assisted review tools.
• Ability to learn payer-specific clinical guidelines quickly.

Responsibilities

• Conduct pre-payment and post-payment clinical reviews of behavioral health records against policies and rubrics.
• Assess medical necessity, documentation sufficiency and level of care; verify coding and billing correctness.
• Document clear findings and rationale; manage appeals as needed.
• Participate in quality assurance calibration and escalate complex cases as needed.

Job description

• Location 209 10Th Ave S, Suite 350, Nashville, TN, 37203-0752, United States
• Job Category Corporate
• Employee Type FT Exempt

Chart Auditor Overview

Our chart auditors perform pre-payment and post-payment reviews of behavioral health records on behalf of health plan customers, confirming that services are medically necessary, clearly documented and billed correctly. We are running selective post-payment review pilots today and preparing to launch pre-payment review, so this is a chance to help shape a service as it scales.

As a Chart Auditor, you will pair your behavioral health clinical expertise with an AI-assisted review platform, working under the guidance of Wayspring's clinical leadership, including an Associate Medical Director who oversees rubric development and clinical review. Your findings will directly shape the rubrics, policies and tools that make our reviews faster, more consistent and more defensible as we expand to additional health plan customers.

Why Wayspring?

We are passionate about breaking barriers alongside those with complex behavioral health needs. Whether you're in the field or in the corporate office - our mission is felt, and your impact is recognized. There is no inner circle, and we all have a seat at the table. Leaders are accessible and silos are avoided. We respect your craft and love to be challenged. We invest not only in our mission, but in each other. Internal promotions and cross departmental training are the norm - you grow, we grow.

Responsibilities of Chart Auditor

Clinical Chart Review

• Conduct pre-payment and post-payment clinical reviews of complex behavioral health medical records against Wayspring policies and rubrics, ASAM criteria, CMS and state Medicaid requirements, health plan policy and other national practice guidelines.
• Assess medical necessity, documentation sufficiency and level of care, and confirm that coding and billing align with the services documented.
• Document clear, defensible findings and rationale for every review and manage appeals, as needed.
• Meet established productivity, accuracy, and turnaround targets.

Quality & Calibration

• Participate in inter-rater reliability exercises and quality assurance calibration sessions to keep review decisions consistent across the team.
• Escalate complex or ambiguous cases to physician reviewers or the Medical Director.
• Identify trends such as provider billing patterns, documentation gaps and potential fraud, waste and abuse for reporting.

Tools, Rubrics & Continuous Improvement

• Use an AI-assisted review platform daily, validating and correcting AI-generated outputs.
• Provide structured feedback that improves the accuracy and usability of review tools.
• Participate in ongoing education and training sessions with clinical leaders to build proficiency in specialized and emerging behavioral health concepts relevant to chart review.
• Recommend refinements to review rubrics and policy content based on what you observe in the charts.

Required Qualifications

• Active CPC, CCS, CCS-P, CPMA, or comparable nationally recognized medical coding/auditing certification required.
• 3+ years of clinical experience in behavioral health and 2+ years in utilization review, chart audit, medical record review or payer-side clinical review.
• Working knowledge of ASAM Criteria and/or other evidence-based behavioral health medical necessity and level-of-care criteria, with the ability to quickly learn and apply payer-specific clinical guidelines.
• Strong written communication, with the ability to document concise, defensible clinical rationale.
• Comfort learning and working in new technology, including web-based and AI-assisted tools.

Preferred Qualifications

• Experience with Medicaid managed care.
• Familiarity with CPT and HCPCS coding and behavioral health billing practices.
• Professional certification such as CPC, CCS, CPMA, CPUR or CCM.
• Experience using AI-assisted or software-based clinical review tools.
• Background in fraud, waste and abuse, payment integrity or special investigations (SIU).
• Experience in a startup or fast-growing organization.

Our goal is to foster a workplace where everyone feels a true sense of belonging, is supported, and empowered to thrive. We actively seek different backgrounds, perspectives, and experiences- because we believe that drives better performance and innovation. We're committed to identifying and removing barriers for the communities we serve.

Benefit Summary

Creating a great employee experience takes more than just perks - but let's be real, those matter too. Here's how we're building a company where you, your family, your pets, and your passions can thrive.

• Comprehensive Medical, Dental and Vision Insurance options - including options for your pets!
• Company funded HSA + Monthly Gym Allowance
• Paid parental leave - all parents included!
• Company paid short term disability, long term disability and life insurance
• 401k with company match
• Premium Employee Assistance Program, inclusive of counseling sessions
• Pardon and Expungement Scholarship Program
• Company Contributions to Future Minded Savings (HSA and Emergency savings fund)
• Generous PTO package (accrual policy based on years of service) and an additional 10 paid company holidays
• Company 2 week paid sabbatical program!