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RN Clinical Auditor - Behavioral Health

Radcube · radcube.com
IndianapolisRemote2+ yrs
Apply on Radcube’s site

Straight from the company’s own careers site.

The job in short

RN clinical auditor reviewing behavioral health medical records and Medicaid billing compliance.

AuditClinicalComplianceExcel

Details

Found
28 d ago · posted 2026-09-22
Role
Registered Nurse (RN)
Source
The company’s own careers site

Full description

This is a remote position. RN Clinical Auditor - Behavioral Health Location: Fully Remote, with occasional travel to Downtown Indianapolis, IN (expenses covered) Job Summary: We are seeking a Registered Nurse Clinical Auditor with extensive Behavioral Health experience to support medical record reviews and billing compliance audits for the Indiana Health Coverage Programs (IHCP). This role evaluates quality of care, reviews medical records and program policies, identifies compliance issues, prepares audit documentation and reports, and supports appeals activities within behavioral health, psychiatric, and substance use disorder treatment settings. Key Responsibilities: • Review medical records and documentation to evaluate provider compliance with IHCP, CMS, AMA, and behavioral health-specific 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 Requirements Required Qualifications:      • Active RN license, Indiana or compact • Extensive Behavioral Health experience (psychiatric units, behavioral health hospitals, substance use disorder treatment, BH utilization review/claims work) • Auditing experience: medical record audits, compliance audits, chart review, or clinical/quality audits. • 2+ year of Medicaid claims review, billing compliance, or healthcare reimbursement experience • Comfortable completing a timed Excel proficiency assessment (sorting, filtering, VLOOKUP, conditional formatting), required by the client prior to submission. Preferred Qualifications: • CCS or CPC coding certification • Indiana Medicaid (IHCP) program familiarity • Knowledge of CPT and ICD-10 coding • Experience with ASAM criteria, InterQual, or MCG guidelines for behavioral health level-of-care determinations • Fraud, waste, and abuse (FWA) exposure

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