Clinical Audit Specialist

Recovery Management Services is seeking a detail-oriented and clinically experienced Clinical Audit Specialist to support behavioral health payer audit and denial management, utilization review, and medical necessity appeals for its counseling and residential detox organizations, On Demand Counseling and New Day Recovery. This role is ideal for a clinician with strong documentation review skills, knowledge of ASAM Criteria, and experience navigating Medicaid, Medicare, MCO, and commercial payer requirements. Hybrid or remote and flexible scheduling is available for qualified candidates seeking part-time work.

ESSENTIAL FUNCTIONS

Coordinate and manage behavioral health payer audits, denials, and utilization review activities Prepare and submit audit responses, appeals, and supporting clinical documentation Defend medical necessity and level-of-care determinations using ASAM Criteria Conduct peer-to-peer reviews and manage payer appeal processes Monitor audit trends, documentation concerns, and compliance risks Collaborate with clinical, compliance, and revenue cycle teams to improve payer outcomes and audit readiness Provide documentation guidance and education related to medical necessity standards

REQUIRED QUALIFICATIONS

Must be at least 18 years of age. Successful completion of BCI/FBI background check and pre-employment drug screen Active or eligible Ohio clinical licensure preferred, including LPC/LPCC, LSW/LISW, or related behavioral health credentials. Independent licensure preferred. Clinical background with expertise in behavioral health documentation, medical necessity review, ASAM Criteria, and utilization review activities including audits and appeals.

SKILLS AND ABILITIES

Strong clinical reasoning, critical thinking, and decision-making skills. In-depth knowledge of behavioral health documentation standards and medical necessity criteria. Working knowledge of HIPAA and 42 CFR Part 2 as they relate to audits and disclosures. Proficiency with EHR systems and Microsoft Office. Ability to manage multiple priorities and meet strict payer deadlines. Clear, professional written and verbal communication skills.

BENEFITS PTO

begins accruing immediately. EOO/DFWP