Audits for clinical gaps in care from a medical and/or behavioral health perspective to ensure ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...
Audits for clinical gaps in care from a medical and/or behavioral health perspective to ensure ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...
... behavioral health. * Audits for trends related to billing compliance and delivers education to ... auditors understand and adhere to billing rules in conducting audits, when needed. * Monitors ...
... behavioral health. * Audits for trends related to billing compliance and delivers education to ... auditors understand and adhere to billing rules in conducting audits, when needed. * Monitors ...
... behavioral health. * Audits for trends related to billing compliance and delivers education to ... auditors understand and adhere to billing rules in conducting audits, when needed. * Monitors ...
... behavioral health. * Audits for trends related to billing compliance and delivers education to ... auditors understand and adhere to billing rules in conducting audits, when needed. * Monitors ...
The inventory auditor reports directly to the Warehouse Manager. Provides a high level of member ... behavioral health/employee assistance, health care reimbursement account, dependent care assistance ...
The inventory auditor reports directly to the Warehouse Manager. Provides a high level of member ... behavioral health/employee assistance, health care reimbursement account, dependent care assistance ...
Inventory Auditor
Southfield, MI · On-site
The inventory auditor reports directly to the Warehouse Manager. Provides a high level of member ... behavioral health/employee assistance, health care reimbursement account, dependent care assistance ...
Inventory Auditor
Southfield, MI · On-site
The inventory auditor reports directly to the Warehouse Manager. Provides a high level of member ... behavioral health/employee assistance, health care reimbursement account, dependent care assistance ...
$38.46 - $52.40/hr
We help healthcare organizations build innovation capabilities and accelerate key growth ... Knows, understands, incorporates, and demonstrates Huron's Vision, and Values in behaviors ...
$38.46 - $52.40/hr
We help healthcare organizations build innovation capabilities and accelerate key growth ... Knows, understands, incorporates, and demonstrates Huron's Vision, and Values in behaviors ...
Inpatient Coding Auditor
Detroit, MI · Remote
$38.46 - $52.40/hr
We help healthcare organizations build innovation capabilities and accelerate key growth ... Knows, understands, incorporates, and demonstrates Huron's Vision, and Values in behaviors ...
Inpatient Coding Auditor
Detroit, MI · Remote
$38.46 - $52.40/hr
We help healthcare organizations build innovation capabilities and accelerate key growth ... Knows, understands, incorporates, and demonstrates Huron's Vision, and Values in behaviors ...
Ensure indisputable credibility through their behavior and the recognition of their experience ... Health & Well-being Coverage From your very first day, you'll have access to medical, dental ...
Ensure indisputable credibility through their behavior and the recognition of their experience ... Health & Well-being Coverage From your very first day, you'll have access to medical, dental ...
Clinical Compliance and Operations Auditor
Dearborn, MI · On-site
$95K - $110K/yr
... state healthcare organization. * Proven track record navigating Medicaid, OIG, and private payor ... Deep mastery of the BACB Ethics Code for Behavior Analysts and HIPAA privacy regulations. * Proven ...
Clinical Compliance and Operations Auditor
Dearborn, MI · On-site
$95K - $110K/yr
... state healthcare organization. * Proven track record navigating Medicaid, OIG, and private payor ... Deep mastery of the BACB Ethics Code for Behavior Analysts and HIPAA privacy regulations. * Proven ...
Clinical Compliance and Operations Auditor
$95K - $110K/yr
... state healthcare organization. * Proven track record navigating Medicaid, OIG, and private payor ... Deep mastery of the BACB Ethics Code for Behavior Analysts and HIPAA privacy regulations. * Proven ...
Clinical Compliance and Operations Auditor
$95K - $110K/yr
... state healthcare organization. * Proven track record navigating Medicaid, OIG, and private payor ... Deep mastery of the BACB Ethics Code for Behavior Analysts and HIPAA privacy regulations. * Proven ...
Clinical Compliance and Operations Auditor
$95K - $110K/yr
... state healthcare organization. * Proven track record navigating Medicaid, OIG, and private payor ... Deep mastery of the BACB Ethics Code for Behavior Analysts and HIPAA privacy regulations. * Proven ...
Clinical Compliance and Operations Auditor
$95K - $110K/yr
... state healthcare organization. * Proven track record navigating Medicaid, OIG, and private payor ... Deep mastery of the BACB Ethics Code for Behavior Analysts and HIPAA privacy regulations. * Proven ...
Reports to either a Director of Behavioral Health, Care Management, or Utilization Management with ... • Monthly auditing of Compliance Risk areas and identification of staff education and ...
Reports to either a Director of Behavioral Health, Care Management, or Utilization Management with ... • Monthly auditing of Compliance Risk areas and identification of staff education and ...
Reports to either a Director of Behavioral Health, Care Management, or Utilization Management with ... Monthly auditing of Compliance Risk areas and identification of staff education and documentation ...
Reports to either a Director of Behavioral Health, Care Management, or Utilization Management with ... Monthly auditing of Compliance Risk areas and identification of staff education and documentation ...
Reports to either a Director of Behavioral Health, Care Management, or Utilization Management with ... · Monthly auditing of Compliance Risk areas and identification of staff education and ...
Reports to either a Director of Behavioral Health, Care Management, or Utilization Management with ... · Monthly auditing of Compliance Risk areas and identification of staff education and ...
ASC/Professional Surgical Coding Auditor & Educator (REMOTE)
Livonia, MI · Remote
$17.50 - $20/hr
... Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions. Work Focus ... Preferred prior experience in auditing and provider education. * Preferred credentials: Certified ...
ASC/Professional Surgical Coding Auditor & Educator (REMOTE)
Livonia, MI · Remote
$17.50 - $20/hr
... Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions. Work Focus ... Preferred prior experience in auditing and provider education. * Preferred credentials: Certified ...
ASC/Professional Surgical Coding Auditor & Educator (REMOTE)
Livonia, MI · On-site +1
$17.50 - $20/hr
... Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions. Work Focus ... Preferred prior experience in auditing and provider education. * Preferred credentials: Certified ...
ASC/Professional Surgical Coding Auditor & Educator (REMOTE)
Livonia, MI · On-site +1
$17.50 - $20/hr
... Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions. Work Focus ... Preferred prior experience in auditing and provider education. * Preferred credentials: Certified ...
Position Summary The Fork Truck Industrial Trainer & Safety Auditor is responsible for promoting ... Identify unsafe behaviors, near misses, and equipment misuse and recommend corrective actions ...
Position Summary The Fork Truck Industrial Trainer & Safety Auditor is responsible for promoting ... Identify unsafe behaviors, near misses, and equipment misuse and recommend corrective actions ...
Position Summary The Fork Truck Industrial Trainer & Safety Auditor is responsible for promoting ... Identify unsafe behaviors, near misses, and equipment misuse and recommend corrective actions ...
Position Summary The Fork Truck Industrial Trainer & Safety Auditor is responsible for promoting ... Identify unsafe behaviors, near misses, and equipment misuse and recommend corrective actions ...
Position Summary The Fork Truck Industrial Trainer & Safety Auditor is responsible for promoting ... Identify unsafe behaviors, near misses, and equipment misuse and recommend corrective actions ...
Position Summary The Fork Truck Industrial Trainer & Safety Auditor is responsible for promoting ... Identify unsafe behaviors, near misses, and equipment misuse and recommend corrective actions ...
Position Summary The Fork Truck Industrial Trainer & Safety Auditor is responsible for promoting ... Identify unsafe behaviors, near misses, and equipment misuse and recommend corrective actions ...
Position Summary The Fork Truck Industrial Trainer & Safety Auditor is responsible for promoting ... Identify unsafe behaviors, near misses, and equipment misuse and recommend corrective actions ...
Behavioral Health Auditor information
What is a behavioral health auditor?
A Behavioral Health Auditor is responsible for reviewing and assessing clinical documentation, billing practices, and compliance with regulatory standards in behavioral health services. They ensure that providers adhere to federal, state, and insurance guidelines while maintaining high-quality patient care. This role involves conducting audits, identifying discrepancies, and recommending corrective actions to improve compliance and efficiency. Auditors may also provide training to staff on best practices and regulatory requirements.
What does a behavioral health auditor do?
A typical day for a Behavioral Health Auditor involves reviewing patient records for compliance with federal, state, and organizational standards, conducting on-site or remote audits, and preparing detailed reports on findings. Auditors often collaborate closely with clinical staff, compliance officers, and management to clarify documentation standards and recommend process improvements. The role may also include participating in policy reviews, providing training or feedback, and staying updated on evolving regulations in behavioral health care. This dynamic environment requires balancing independent analysis with teamwork and periodic travel for on-site reviews.
What are the key skills and qualifications needed to thrive as a behavioral health auditor?
To thrive as a Behavioral Health Auditor, you need a strong background in clinical compliance, behavioral health standards, and audit processes, often supported by a degree in healthcare or related fields and experience in behavioral health settings. Familiarity with auditing software, electronic health records (EHR) systems, and certifications such as Certified Professional Medical Auditor (CPMA) are highly valuable. Strong analytical skills, attention to detail, effective communication, and the ability to navigate sensitive situations with professionalism are crucial soft skills. These competencies ensure accurate assessments, regulatory compliance, and constructive feedback that supports quality improvement in behavioral health organizations.
What are the most commonly searched types of Behavioral Health Auditor jobs in Michigan?
The most popular types of Behavioral Health Auditor jobs in Michigan are:
What are popular job titles related to Behavioral Health Auditor jobs in Michigan?
For Behavioral Health Auditor jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Behavioral Health Auditor jobs in Michigan look for?
The top searched job categories for Behavioral Health Auditor jobs in Michigan are:
Auditor, Healthcare Services (Remote in MI)
Detroit, MI • Remote
Molina Healthcare •
Health Care and Social Assistance • 10K+ employees10,000+ employees
8.0
Based on 199 frontline employees who took The Breakroom Quiz
170th of 315 rated insurance
People enjoy working here
Good employer
Recommended by students
Recommended by parents
Respectful managers
Full-time
Re-posted 8 days ago
Job description
JOB DESCRIPTION
This position will offer remote work flexibility, but the selected candidate must reside in Michigan.
Opportunity for an RN who has a US license in good standing to join our Medicaid Team as a Clinical Auditor. The person filling this role will be an instrumental part of the team work to align the Medicaid Team compliance guidelines with those followed by our corporate teams. Knowledge and experience working with Waiver Program is vital to success in this role.
The preferred candidate will have 3 - 5 years of experience in a MCO and at least 2 years of clinical auditing and/or review experience. Mastery of Microsoft Office, especially Excel, PowerPoint will also be skill sets we are seeking. Licensure should be an LPC, RN, LLMSW, LMSW, LBSW.
Hours are Monday - Friday, 8:30AM - 5PM EST.
Job Summary
Provides support for healthcare services clinical auditing activities. Performs audits for clinical functional areas in alignment with regulatory requirements - ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
Performs audits in utilization management, care management, member assessment, behavioral health, and/or other clinical teams, and monitors clinical staff for compliance with National Committee for Quality Assurance, Centers for Medicare and Medicaid Services (CMS), and state/federal guidelines and requirements. May also perform non-clinical system and process audits as needed.
Audits for clinical gaps in care from a medical and/or behavioral health perspective to ensure member needs are being met.
Assesses clinical staff regarding appropriate clinical decision-making.
Reports monthly outcomes, identifies areas of re-training for staff, and communicates findings to leadership.
Ensures auditing approaches follow a Molina standard in approach and tool use.
Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA), and professionalism in all communications.
Adheres to departmental standards, policies and protocols.
Maintains detailed records of auditing results.
Assists healthcare services training team with developing training materials or job aids as needed to address findings in audit results.
Meets minimum production standards related to clinical auditing.
May conduct staff trainings as needed. Communicates with quality and/or healthcare services leadership regarding issues identified, and works collaboratively to subsequently resolve/correct.
Required Qualifications
At least 2 years health care experience, with at least 1 year experience in utilization management, care management, and/or managed care, or equivalent combination of relevant education and experience.
Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
Strong attention to detail and organizational skills.
Strong analytical and problem-solving skills.
Ability to work in a cross-functional, professional environment.
Ability to work on a team and independently. Excellent verbal and written communication skills.
Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
Utilization management, care management, behavioral health and/or long-term services and supports (LTSS) clinical review/auditing experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
About Molina Healthcare
Sourced by ZipRecruiter
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Long Beach, CA, US
Year founded
1980
Website
What Molina Healthcare employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom