RN Clinical Auditor – Behavioral Health

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔎 Auditor

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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RADcube

WebsiteLinkedInAll Job Openings

201 - 500 employees

💼 Consulting

🏥 Healthcare

📦 Logistics

Consulting • Healthcare • Logistics

<RADcube> is a global technology and systems integration partner that designs and delivers production-ready AI platforms through RADlabs, focusing on governed, secure, and enterprise-scale solutions. The company builds governed AI and agentic systems, intelligent document processing (HIPAA-aware), data engineering and analytics, cloud & DevOps, cybersecurity & GRC, and process automation to modernize systems, operationalize AI, and scale innovation with an emphasis on security, compliance, and Responsible AI. RADcube serves multiple industries including government, health & life sciences, banking & finance, e-commerce, manufacturing, transportation & logistics, and education.

📋 Description

• 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 • Provide preliminary findings to the Lead Reviewer • Identify documentation deficiencies and billing compliance issues within psychiatric and behavioral health 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

• Active RN license, Indiana or compact • Extensive Behavioral Health experience, including psychiatric units, behavioral health hospitals, substance use disorder treatment, or behavioral health utilization review/claims work • Auditing experience in medical record audits, compliance audits, chart review, or clinical/quality audits • 2+ years of Medicaid claims review, billing compliance, or healthcare reimbursement experience • Comfortable completing a timed Excel proficiency assessment covering sorting, filtering, VLOOKUP, and conditional formatting • CCS or CPC coding certification preferred • Indiana Medicaid (IHCP) program familiarity preferred • Knowledge of CPT and ICD-10 coding preferred • Experience with ASAM criteria, InterQual, or MCG guidelines for behavioral health level-of-care determinations preferred • Fraud, waste, and abuse (FWA) exposure preferred

🏖️ Benefits

• Occasional travel expenses to Downtown Indianapolis, IN are covered