Clinical Provider Auditor I - Maryland Behavioral Health
Core
Examines claims for compliance with billing guidelines to identify fraud, abuse, and errors in behavioral health care payments.
Role type
Field-based medical auditor (behavioral health)
Builds
Fraud prevention controls and accurate payment determinations for behavioral health claims
Domain
Healthcare / Behavioral Health / Medical Billing & Auditing
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Medical coding, Claims auditing, Fraud detection, Medical record review, Regulatory compliance research, Loss control recommendations
Preferred skills
ICD-10 coding, CPT/HCPC coding, Behavioral health coding experience
Technologies
Required systems/tools for claims documentation and analysis
Responsibilities
Examines claims for compliance with billing guidelines, Reviews and analyzes claims and medical records prior to payment, Researches healthcare laws and coding trends, Collaborates with Special Investigation Unit, Recommends interventions for loss control
Seniority
Entry-level (1 year experience required)