Medical Audit Specialist (Behavioral Health)
About The Position
The Behavioral Health Medical Audit Specialist ensures compliance with OHCA policies, state statutes, and federal regulations by providing clinical expertise in conducting comprehensive audits and investigations to identify and address fraud, waste, and abuse within behavioral health services. The role involves evaluating the clinical appropriateness of billed services, analyzing documentation, and collaborating with internal and external stakeholders to communicate findings and make necessary referrals. This position plays a critical role in maintaining the integrity of Medicaid behavioral health services while supporting the agency’s mission of providing Oklahomans with better health care.
Requirements
- Current professional licensure in Behavioral Health
- 3 years of professional experience
- In-depth knowledge of agency policies, state and federal regulations, and behavioral health clinical practices
- Strong analytical skills and attention to detail
- Excellent communication and collaboration abilities
- Resume/CV with complete work and education history
Nice To Haves
- Certifications in any of the following areas: Certified Fraud Examiner (CFE), Certified Professional Medical Auditor (CPMA), Certification in Healthcare Compliance (CHC), or Project Management Professional (PMP) or Lean Six Sigma Certification
Responsibilities
- Provide clinical expertise in conducting investigations and completing comprehensive clinical audits in an effort to combat fraud, waste, and abuse.
- Ensure billing compliance with OHCA policy, state statutes, and federal regulations.
- Performs analysis and evaluation of billed services including claims and documentation to ensure all HCA policy requirements are met and services are clinically/medically appropriate.
- Collaborate with others across the unit, organization, and external entities to evaluate audit results and make referrals to appropriate parties.
- Communicate audit findings to all stakeholders.
- Represents the Provider Audits Unit in ALJ legal proceedings in an informed and professional manner.
- Maintain licensure and certifications.
- Other duties as assigned.
Benefits
- Generous state-paid benefit allowance to offset insurance premiums.
- A wide selection of insurance plans with no pre-existing condition exclusions.
- Flexible Spending Accounts for health care and dependent care.
- Retirement Savings Plan with employer contributions.
- 11 paid holidays annually.
- 15 days of vacation and 15 days of sick leave in the first year.
- Longevity Bonus recognizing years of public service.
- Public Service Loan Forgiveness eligibility and tuition reimbursement.
- Wellness benefits, including an on-site gym and fitness center discounts.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
