Behavioral Health Coding Auditor

Job not on LinkedIn

October 13

⚓ Rhode Island – Remote

Although this job is listed in Rhode Island, this company may be open to hiring remote in other states.

⏳ Contract/Temporary

🟡 Mid-level

🟠 Senior

🔎 Auditor

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Shyft6

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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.

201 - 500 employees

Founded 2019

👥 HR Tech

🎯 Recruiter

🤝 B2B

📋 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