Behavioral Health Specialist

Chimes•Baltimore, MD

About The Position

Chimes is seeking a Behavioral Health Specialist to join its Compliance team. The role supports regulatory compliance, accurate clinical documentation, and quality services for individuals with intellectual and developmental disabilities. The specialist conducts audits and investigations, reviews clinical records and billing documentation, monitors required clinical services, and helps develop corrective actions and quality improvements. The position involves collaboration with program leadership and travel to agency locations for audits, investigations, and site visits.

Requirements

Active CPC or CPC-A Medical Coding Certification.
Minimum of four years of professional experience in behavioral health, healthcare compliance, quality assurance, clinical documentation, auditing, or a related field.
Knowledge of behavioral health documentation, regulatory requirements, and compliance practices.
Familiarity with CPT, revenue, and diagnostic coding.
Strong analytical, investigative, organizational, and problem-solving skills.
Excellent written and verbal communication skills.
Proficiency in Microsoft Office, particularly Word and Excel.
Ability to maintain confidentiality, manage multiple priorities, and work independently.
Ability to travel between agency locations as needed.

Nice To Haves

Bachelor's degree in Behavioral Health or a related field.
Experience with medical credentialing.
Experience supporting individuals with intellectual and/or developmental disabilities.
Knowledge of Medicare, Medicaid, and commercial insurance requirements.

Responsibilities

Conduct scheduled and unannounced audits of programs, clinical records, documentation, and compliance activities.
Review behavioral health and clinical documentation for accuracy, completeness, and regulatory compliance.
Monitor compliance with psychological, nursing, behavioral health, and other required clinical services.
Assist with investigations, identify compliance concerns, and recommend corrective actions.
Develop and monitor Plans of Correction resulting from audits, investigations, and regulatory reviews.
Review clinical records, claims, CPT codes, and billing documentation to identify potential compliance issues.
Evaluate applicable Medicare, Medicaid, and commercial insurance requirements.
Prepare audit reports, compliance findings, and recommendations for leadership.
Provide guidance and training to staff regarding documentation, regulatory requirements, and quality improvement.
Collaborate with program leadership and travel to agency locations for audits, investigations, and site visits.