Shyft6
HR Tech • Recruitment • B2B
Shyft6 is a trusted partner for innovative companies, specializing in workforce solutions that encompass staffing and recruiting, workforce management, and human capital strategy. With over 26 years of combined experience, Shyft6 offers a comprehensive range of services including contingent workforce supplier management, recruitment process outsourcing, staff augmentation, executive search, and multi-state payroll. Their focus is on empowering organizations through effective workforce development and project management, ensuring successful delivery and skilled talent acquisition.
Behavioral Health Coding Auditor
Job not on LinkedIn
October 13
Shyft6
HR Tech • Recruitment • B2B
Shyft6 is a trusted partner for innovative companies, specializing in workforce solutions that encompass staffing and recruiting, workforce management, and human capital strategy. With over 26 years of combined experience, Shyft6 offers a comprehensive range of services including contingent workforce supplier management, recruitment process outsourcing, staff augmentation, executive search, and multi-state payroll. Their focus is on empowering organizations through effective workforce development and project management, ensuring successful delivery and skilled talent acquisition.
đź“‹ Description
• Perform retrospective and prospective audits of Behavioral Health claims and encounters (CPT/HCPCS/ICD-10). • Evaluate accuracy, completeness, and adherence to payer and Medicaid guidelines with emphasis on Rhode Island Medicaid policy requirements. • Analyze denial trends, under/overpayments, edits, and provider coding patterns; quantify impact and root causes. • Draft clear, actionable coding rule definitions and edit logic recommendations (e.g., medical necessity, bundling/unbundling, frequency limits). • Align recommendations to CMS/NCCI, state Medicaid policy, and payer policy; highlight provider education needs. • Collaborate with configuration/benefits/claims ops teams to translate recommendations into system configuration and edits. • Create concise audit reports, dashboards, and provider feedback packets. • Define KPIs (accuracy rate, first-pass adjudication, denial reduction, net financial impact) and build a lightweight tracking plan.
🎯 Requirements
• Active coding certification: CPC, CCS, RHIT, RHIA, or equivalent. • Behavioral Health depth: Proven experience auditing and coding across outpatient/inpatient behavioral health services (e.g., psychotherapy, psychiatry services, IOP/PHP, MAT, SUD). • Code sets & guidelines: Advanced proficiency in CPT, HCPCS, and ICD-10 with provider-side interpretation and payer-side application. • Medicaid expertise: Hands-on experience with Medicaid programs and policy; familiarity with Rhode Island Medicaid requirements and documentation standards. • Payer environment: Background working with health plans/TPAs on claims adjudication, policy, and edits. • Analytical & communication skills: Ability to turn audit findings into crisp recommendations and present them to technical and non-technical audiences. • Tools: Strong Excel/Sheets; comfort with claims data extracts and basic BI/reporting.
🏖️ Benefits
• Health insurance • Flexible working arrangements • Professional development opportunities
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