Senior Behavioral Health Compliance Auditor

Istss; Northern (KY); Hybrid; USD 54,000 - 117,000; Full time

Benefits offered by this job

Comprehensive benefits

Bonus eligibility

Paid time off

Job summary

CVS Health is seeking a Behavioral Health Auditor to review medical and behavioral health records for regulatory and coding compliance. The role involves audits across Medicaid and behavioral health services, collaboration with providers, and development of corrective action plans.

The ideal candidate holds a Master’s degree, a current Louisiana license, and 5+ years in behavioral health with experience reviewing claims data. Travel up to 25% in Louisiana is required.

Qualifications

• Licensed Mental Health Provider in Louisiana with licensure up to date.
• 5+ years in behavioral health practice.
• 3–5 years reviewing claims data and clinical documentation.
• Strong knowledge of regulatory and documentation standards.
• Proficient with digital health systems and data analysis.

Responsibilities

• Complete medical, behavioral health, and clinical audits.
• Audit provider records for coding and documentation compliance.
• Develop and monitor corrective action plans for providers.
• Maintain audit records using designated tools.
• Participate in inter-rater reliability activities.
• Support FWA prevention and detection initiatives.
• Provide education on regulatory requirements and coding guidelines.
• Collaborate with providers to improve compliance and quality.
• Monitor regulatory changes and inform leadership.

Skills

Louisiana licensure

Behavioral health exp

Claims review

Problem solving

Digital systems

Communication skills

Travel willingness

Coder certification

Education

Master's degree

Job description

CVS Health is seeking a Behavioral Health Auditor to review medical and behavioral health records for regulatory and coding compliance. The role involves audits across Medicaid and behavioral health services, collaboration with providers, and development of corrective action plans.

The ideal candidate holds a Master’s degree, a current Louisiana license, and 5+ years in behavioral health with experience reviewing claims data. Travel up to 25% in Louisiana is required.