Remote Behavioral Health Quality Improvement Specialist

Sentara Health; Indiana; Remote; USD 74,000 - 123,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

401k/403B with employer match

Paid Time Off

Tuition Assistance

Student Debt Pay Down

Life Insurance

Disability insurance

Paid Parental Leave

Job summary

Sentara Health is seeking a Remote Quality Improvement Specialist to conduct comprehensive reviews of behavioral health claims prior to payment, ensuring medical necessity and regulatory compliance.

The role collaborates with providers, compliance, and claims teams across multiple states, with base pay in the range shown plus a comprehensive benefits package. Remote opportunity with flexibility and growth potential.

Qualifications

• Bachelor's degree in health administration or health-related field required.
• Minimum 2 years Medicaid/Managed Care experience.
• Minimum 2 years Quality Improvement experience.
• Knowledge of Medicaid behavioral health regulations.

Responsibilities

• Conduct comprehensive clinical and documentation reviews of behavioral health claims prior to payment.
• Collaborate with providers, compliance departments, and claims operations to ensure accurate reimbursement.
• Ensure adherence to state and federal regulations and organizational policies.

Skills

Behavioral health knowledge

Medicaid regulations

Clinical record interpretation

Claims/billing knowledge

Critical thinking

Evidence-based decisions

Communication skills

MS Office & audit tools

Education

Bachelor's degree in health administration or related field

RN license preferred

LCSW/LPC/LMFT/BCBA/LMHP licenses preferred

Job description

Sentara Health is seeking a Remote Quality Improvement Specialist to conduct comprehensive reviews of behavioral health claims prior to payment, ensuring medical necessity and regulatory compliance.

The role collaborates with providers, compliance, and claims teams across multiple states, with base pay in the range shown plus a comprehensive benefits package. Remote opportunity with flexibility and growth potential.