Remote RN Clinical Auditor - Behavioral Health

RADcube; Indianapolis (IN); Remote; USD 70,000 - 95,000; Full time

Job summary

RADcube is seeking a Registered Nurse Clinical Auditor with extensive Behavioral Health experience to support IHCP medical record reviews and billing compliance audits. This fully remote role includes occasional travel to Downtown Indianapolis, IN (expenses covered) to collaborate with the audit team and key stakeholders.

You will evaluate care quality, review policies, identify compliance issues, prepare documentation, and assist with appeals in behavioral health and substance use disorder

Qualifications

• Active RN license in Indiana or a compact state.
• Extensive Behavioral Health experience in psychiatric units or BH hospitals.
• Auditing experience: medical record or compliance audits.
• 2+ years Medicaid claims review or healthcare reimbursement experience.
• Excel proficiency; timed assessment may be required.

Responsibilities

• Review medical records and documentation to evaluate provider compliance with IHCP, CMS, AMA, and behavioral health standards.
• Conduct medical record and compliance reviews independently, providing preliminary findings to the Lead Reviewer.
• Identify documentation deficiencies and billing compliance issues within psychiatric/BH claims.
• Maintain detailed workpapers documenting procedures, findings, and conclusions.
• Assist with audit responses and appeals as needed.
• Stay current on Indiana Medicaid behavioral health policy and regulatory updates.

Skills

RN license

Behavioral Health experience

Auditing experience

Medicaid claims review

Excel proficiency

Education

Nursing degree (RN)

Tools

Excel

Job description

RADcube is seeking a Registered Nurse Clinical Auditor with extensive Behavioral Health experience to support IHCP medical record reviews and billing compliance audits. This fully remote role includes occasional travel to Downtown Indianapolis, IN (expenses covered) to collaborate with the audit team and key stakeholders.

You will evaluate care quality, review policies, identify compliance issues, prepare documentation, and assist with appeals in behavioral health and substance use disorder