Clinical Provider Auditor II - Maryland Behavioral Health

About the role

The Clinical Provider Auditor II supports Payment Integrity and Behavioral Health Care. This role is field-based, enabling associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training.

Responsibilities

• Examines claims for compliance with relevant billing and processing guidelines and identifies opportunities for fraud and abuse prevention and control.
• Reviews and conducts analysis of claims and medical records prior to payment and uses required systems/tools to accurately document determinations and continue to next step in the claims lifecycle.
• Researches new healthcare related questions as necessary to aid in investigations and stays abreast of current medical coding and billing issues, trends and changes in laws/regulations.
• Collaborates with the Special Investigation Unit and other internal areas on matters of mutual concern.
• Recommends possible interventions for loss control and risk avoidance based on the outcome of the investigation.
• Affords assistance in training of new associates.

Requirements

• Requires a AA/AS and minimum of 3 years medical coding/auditing experience, including minimum of 1 year in fraud, waste abuse experience; or any combination of education and experience, which would provide an equivalent background.
• Requires coding certification (CPC, CCS, CPMA).

Preferred Skills, Capabilities and Experiences

• Knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology.
• Bachelor’s degree strongly preferred.
• Behavioral Health coding and auditing experience preferred.

Pay

The salary range for this specific position is $61,320.00 - $76,650.00.

Schedule

This role is field-based, requiring travel to client sites or designated locations as needed, with occasional office attendance for meetings or training.