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9h ago Curated

Clinical Provider Auditor Lead - Maryland Behavioral Health

Elevance Health

Job description

The Clinical Provider Auditor Lead is responsible for conducting clinical audits of behavioral health providers to ensure compliance with regulatory and contractual requirements. This role involves reviewing medical records, claims, and documentation to identify overpayments, underpayments, and quality of care issues. The position is fully remote but requires residence in Maryland. Requires an active RN license in Maryland, 5+ years of clinical experience in behavioral health, and experience with provider auditing. Salary range: $80,000–$120,000.

Key responsibilities

  • Conduct clinical audits of behavioral health providers
  • Review medical records and claims for compliance
  • Identify overpayments, underpayments, and quality issues
  • Prepare audit reports and recommendations

What you bring

  • Active RN license in Maryland
  • 5+ years clinical experience in behavioral health
  • Experience with provider auditing
  • Knowledge of regulatory requirements

Tags

RemoteBehavioral HealthAuditorMaryland

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