Registered Nurse- Clinical Auditor
Job Title: Registered Nurse Clinical Auditor - Junior Location: Remote with Occasional travel - Downtown Indianapolis, IN We are seeking a detail-oriented Registered Nurse to support medical record reviews, billing compliance audits for the Indiana Health Coverage Programs. This role is responsible for evaluating quality of care, reviewing medical records and program policies and identifying compliance issues, preparing audit documentation and reports, and supporting appeals activities. The ideal candidate brings clinical knowledge, regulatory awareness, and strong analytical and writing skills. This is a remote position with occasional travel required within Indiana. RN Clinical Auditor - Behavioral Health Location: Fully Remote, with occasional travel to Downtown Indianapolis, IN 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
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)
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