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Behavioral Health Group - BHG · 6 hours ago

Compliance Auditor

United States

Full-time

Remote

Mid Level

Behavioral Health Group - BHG is seeking a Compliance RCM Auditor responsible for reviewing and verifying compliance regulations in healthcare revenue cycle management. The role involves conducting audits, analyzing medical records, and providing recommendations to ensure accurate billing and compliance with federal and state laws.

Addiction TreatmentHealth CareInsuranceOutpatient CarePayments

Responsibilities

Reviewing medical records: Analyzing patient charts to ensure proper diagnosis and procedure coding (CPT, ICD-10, HCPCS) accuracy against billing claims

Claims auditing: Assessing submitted claims for compliance with payer contracts, including verifying patient demographics, insurance eligibility, and billing codes

Data analysis: Utilizing data analytics tools to identify patterns of potential compliance issues, such as high denial rates or unusual coding trends

Contract compliance: Reviewing payer contracts to ensure accurate billing practices and appropriate reimbursement based on contract terms

Documentation review: Checking for complete and accurate documentation supporting medical necessity for billed services

Identifying areas for improvement: Reporting findings and providing recommendations to improve RCM processes and mitigate compliance risks

Investigating complaints: Reviewing potential compliance concerns raised by patients, payers, or internal stakeholders

Reporting and documentation: Preparing detailed audit reports with findings, corrective action plans, and supporting documentation

Responsible for complying with all federal, state and local regulatory agency requirements

Responsible for complying with all accrediting agencies

Qualification

Compliance Auditing experienceHealthcare coding expertiseMedical coding systems knowledgeHealthcare compliance lawsRCM audit experienceData analysis skillsCertified Professional CoderMeticulous approachEffective communication

Required

Compliance Auditing experience required, preferred experience in behavioral health and/or substance abuse auditing

Proven expertise in healthcare coding, preferably within mental and behavioral health, or substance abuse strongly preferred

Thorough understanding of medical coding systems (CPT, ICD-10, HCPCS) and their application in clinical practice

Deep familiarity with HIPAA, Medicare, Medicaid, and other relevant healthcare compliance laws

Proven experience conducting RCM audits, including sample selection, data analysis, and report writing

Ability to analyze complex data, identify trends, and draw accurate conclusions

Meticulous approach to reviewing medical records and billing data to ensure accuracy

Effective communication with healthcare providers, billing staff, and management to discuss audit findings and recommendations

The Compliance RCM Auditor must comply with federal and state regulations regarding certification, licensure, and degree

Preferred

Certified Professional Coder (CPC) and/or Certified Professional Medical Auditor (CPMA) or CIA strongly preferred. If not certified, willing to pursue certification

Company

Behavioral Health Group - BHG

Behavioral Health Group (BHG) is the largest network of Joint Commission-accredited outpatient opioid treatment and recovery centers in the U.S., delivering comprehensive, personalized evidence-based medical and behavioral therapies for individuals with opioid use disorder.

Founded in 2006