[Hiring] Behavioral Health Auditor @CVS Health

Role Description

The Behavioral Health Auditor is responsible for reviewing medical, behavioral health, and other healthcare provider records to ensure compliance with coding, documentation, state, federal, and regulatory requirements, including standards established by the Louisiana Department of Health and Office of Behavioral Health. The Auditor must be able to determine coding accuracy and documentation appropriateness through record reviews and audits.

• Conduct provider audits.
• Identify coding and documentation deficiencies.
• Recognize concerning billing patterns or trends.
• Recommend appropriate follow-up actions, including:
  • Provider education.
  • Corrective action plans.
  • Referrals for suspected fraud, waste, and abuse (FWA).
• Collaborate with internal and external stakeholders to support audit activities.
• Ensure regulatory compliance.
• Assist with FWA prevention and detection efforts.
• Provide technical assistance and education to providers.
• Support continuous quality improvement initiatives.
• Maintain professional competency and remain informed of evolving regulatory requirements and industry best practices.

Qualifications

• Licensed Mental Health Provider in the State of Louisiana, in good standing and without restrictions (LPC, LMFT, LCSW, LMSW, APRN).
• Minimum of five (5) years of professional work experience, including experience in behavioral health services.
• Three (3) to five (5) years of experience reviewing and interpreting claims data, medical records, and clinical documentation.
• Knowledge of behavioral health documentation requirements, evidence-based treatment practices, and regulatory standards.
• Knowledge of medical terminology and healthcare documentation standards.
• Strong problem-solving and decision-making skills.
• Proficiency with digital systems and technology applications.
• Ability to interpret and analyze clinical, claims, and audit data.
• Ability to handle sensitive and confidential information ethically and responsibly.
• Ability to communicate effectively and interact professionally with providers, members, customers, and community partners.
• Ability to function effectively within clinical environments and work with diverse patient and staff populations.
• Ability to evaluate risks, costs, and benefits when making recommendations and decisions.
• Must reside in Louisiana.
• Willingness to travel up to 25% throughout Louisiana.
• Willingness to work Monday through Friday, 8:00 a.m. to 5:00 p.m. Central Time.
• Must possess, or be willing to obtain, a Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Professional Medical Auditor (CPMA) certification.
• Master’s degree.

Preferred Qualifications

• Previous auditing experience.
• Previous experience in an outpatient behavioral health setting.
• Previous experience working with medical records and/or electronic health records (EHRs).
• Previous Medicaid, managed care, or health plan experience.
• Previous experience with Louisiana Department of Health and/or Office of Behavioral Health regulations and provider requirements.
• Previous experience with Quickbase.
• Strong organizational and time management skills.
• Demonstrated ability to work independently and manage multiple priorities.
• Strong analytical, critical thinking, and problem-solving abilities.
• Exceptional attention to detail and accuracy.
• Ability to learn quickly and adapt to changing priorities and regulatory requirements.
• Strong relationship-building and collaboration skills.
• Excellent written, verbal, and presentation skills.
• Ability to work effectively both independently and as part of a team.
• Demonstrated flexibility and adaptability in a dynamic work environment.

Education

• Master's degree

Anticipated Weekly Hours

• 40

Time Type

• Full time

Pay Range

The typical pay range for this role is: $54,095.00 - $116,760.00. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Benefits

• Comprehensive and competitive mix of pay and benefits.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.