Behavioral Health Clinical Reviewer

Acentra Health, LLC

3d•$29 - $36

About The Position

Acentra Health is looking for a Behavioral Health Clinical Reviewer to join our growing team. The purpose of this position is to conduct administrative and process-based reviews of medical records related to Applied Behavior Analysis (ABA) services. The BCBA Clinical Reviewer evaluates documentation against established criteria and contractual requirements to determine medical appropriateness. This role does not involve direct clinical judgment regarding patient care or therapeutic decisions. Instead, the focus is on ensuring compliance, accuracy, and completeness of ABA documentation in accordance with applicable guidelines.

Requirements

Master’s degree in psychology, Behavior Analysis, or another relevant field is required
Requires 4+ years of experience in Applied Behavior Analysis (ABA) or a related clinical field
Requires certification as a Board-Certified Behavior Analyst (BCBA)
Strong clinical assessment and critical thinking skills required
Medical record abstracting skills required
Knowledge of the organization of medical records, medical terminology, and disease process required

Nice To Haves

Excellent written and verbal communication skills and the ability to collaborate with families and other medical professionals
Utilization review and/or case management experience is preferred
Medicaid/Medicare/Commercial experience is preferred
Understanding of ABA principles, clinical practices, and therapeutic techniques

Responsibilities

Conduct prospective reviews of Behavioral Health services, with a focus on Applied Behavior Analysis (ABA)
Evaluate age-appropriate testing, evaluation, and assessment tools to determine the appropriateness of ABA therapy
Ensure accuracy and timeliness of all review types in accordance with contract requirements
Monitor and manage daily workload and review queues, adjusting schedules as needed to meet departmental demands
Collaborate with the Supervisor on quality monitoring activities, identifying areas for improvement and supporting implementation efforts
Maintain current knowledge of review processes, clinical practices, and relevant guidelines
Serve as the first-line reviewer for ABA prior authorization requests, based on workload needs
Act as a liaison and resource for providers, addressing client/patient service issues and facilitating problem resolution
Foster positive, professional relationships with internal and external stakeholders to support effective review processes
Participate in training sessions and scheduled meetings to stay updated on review protocols and industry standards
Adhere to all corporate policies, including those related to HIPAA Privacy and Security Rules