Compliance Auditor (Behavioral Health)

Job Summary This Agency is seeking an experienced Compliance Auditor with deep knowledge of North Carolina behavioral health regulations, Medicaid managed care audit processes, and accreditation standards. This is a specialized role for someone who has personally audited or been audited in the NC behavioral health space — not a general healthcare compliance role. The Compliance Auditor partners with agency leadership to conduct internal audits, prepare for external audits, identify documentation and operational risks before they become findings, and support the agency's pursuit of Joint Commission accreditation. The role reports directly to the CEO to preserve auditor independence from the operational and clinical leadership whose work is being audited.

Reporting Structure:

Direct report: Owner / CEO — for all audit findings, recommendations, scope decisions, and contract matters. This direct reporting line preserves the independence required for the audit function.

Cross-functional collaboration:

Works closely with the Operations Director, Clinical Director, PA Supervisor, and Medical Records Coordinator to gather information, request records, and communicate findings.

No direct reports:

The Compliance Auditor does not supervise staff. Findings are delivered to the CEO; remediation is implemented by the responsible department leader under their direction.

Core Responsibilities:

Internal chart audits. Conduct routine and targeted clinical chart audits across SACOT, SAIOP, Outpatient Therapy, Peer Support Services, and other agency service lines. Verify documentation completeness, billing-defensibility, and alignment with NC Medicaid Clinical Coverage Policies (8A, 8C, and others as applicable). MCO audit preparation and response. Prepare the agency for Clinical Quality Reviews (CQRs), post-payment audits, focused reviews, and other MCO-initiated audits across Alliance Health, Trillium Health Resources, AmeriHealth Caritas, Carolina Complete Health, NC Healthy Blue, UnitedHealthcare Community Plan, Vaya Health, and Partners. Coordinate document production, review responses for accuracy, and support the agency through the audit lifecycle. Documentation standards and gap identification . Identify systemic documentation gaps (CCA timeliness, PCP signature, treatment plan reviews, group note duplication, ratio compliance) and recommend corrective actions to leadership before they become external audit findings. Joint Commission and CARF accreditation support . Support the agency's Joint Commission pursuit by reviewing standards alignment across clinical, environmental, and human resources domains. Conduct mock surveys, identify gaps, and recommend policy or process changes. Policy and procedure review. Review agency policies and procedures against current NC DHSR rules, NC Medicaid

CCP, MCO

contract requirements, NCSAPPB and

NCBLCMHC

supervisor rules, HIPAA, 42 CFR Part 2, and accreditation standards. Recommend updates as regulations change. Credentialing audit support. Verify clinician licensure and credential status, supervision agreements, and payer-specific credentialing alignment. Identify mismatches between clinician credentials and the services they are billing. Service-line ratio and program compliance. Audit SACOT and SAIOP staffing ratios, group sizes, hours of operation, and program structure against NC Medicaid CCP 8A and related policies. Findings reports and corrective action plans . Produce written audit findings reports with prioritized recommendations and proposed corrective action plans. Track corrective action progress through closure. Quarterly executive briefings. Provide the CEO with quarterly compliance briefings summarizing audit activity, findings trends, regulatory changes, and accreditation readiness status. Required Qualifications Bachelor's degree in healthcare administration, nursing, or a related field; relevant certifications preferred. Minimum five (5) years of compliance, audit, quality assurance, or clinical operations experience in a North Carolina behavioral health agency, MCO, DHHS-licensed facility, or equivalent setting. Demonstrated, hands-on experience with NC Medicaid MCO audits — including Clinical Quality Reviews, post-payment audits, or focused reviews from Alliance, Trillium, AmeriHealth, or other NC MCOs. Experience surviving these audits, not just reading about them. Working knowledge of NC Medicaid Clinical Coverage Policies, particularly CCP 8A (substance use services) and CCP 8C (outpatient therapy). Working knowledge of NC DHSR licensure rules, NCSAPPB and

NCBLCMHC

supervisor requirements, HIPAA, and 42 CFR Part 2 confidentiality. Working knowledge of behavioral health service codes, group ratios, documentation timelines, and billing-defensible documentation standards. Strong written communication skills; ability to produce clear, organized, prioritized findings reports. Ability to work independently, manage own schedule, and meet deliverable timelines. Active LCAS, LCMHC, LCSW, RN, CCS, or equivalent NC-recognized credential strongly preferred (not strictly required for the auditor role). Successful completion of background check and any agency-required onboarding documentation. Preferred Qualifications Direct experience as a Joint Commission or CARF surveyor, or hands-on participation in a Joint Commission or CARF accreditation cycle as a clinical or compliance lead. Prior employment with a North Carolina MCO (Alliance, Trillium, AmeriHealth, etc.) on the clinical, audit, or quality side. Certified in Healthcare Compliance (CHC) or Healthcare Privacy Compliance (CHPC). Prior experience auditing across multiple BH service lines (SACOT, SAIOP, OPT, Peer Support, Mobile Crisis, Tailored Care Management). Familiarity with the Checkpoint EHR and other NC behavioral health EHR systems. Auditor Independence To preserve the integrity of the audit function, the Compliance Auditor reports directly to the CEO and operates independently of the operational and clinical leadership whose work is being audited. The Compliance Auditor does not have operational decision-making authority, does not supervise agency staff, and does not own remediation of identified findings. The auditor's role is to identify and recommend; remediation is owned by the responsible department leader under the direction of the CEO.

Pay:

$500.00

• $1,000.

00 per week People with a criminal record are encouraged to apply

Work Location:

Hybrid remote in Raleigh, NC 27634 Compliance Auditor (Behavioral Health) Raleigh, NC 27634 Hybrid work $500

• $1,000 a week
• Contract $500
• $1,000 a week
• Contract Job Summary This Agency is seeking an experienced Compliance Auditor with deep knowledge of North Carolina behavioral health regulations, Medicaid managed care audit processes, and accreditation standards.

This is a specialized role for someone who has personally audited or been audited in the NC behavioral health space — not a general healthcare compliance role. The Compliance Auditor partners with agency leadership to conduct internal audits, prepare for external audits, identify documentation and operational risks before they become findings, and support the agency's pursuit of Joint Commission accreditation. The role reports directly to the CEO to preserve auditor independence from the operational and clinical leadership whose work is being audited.

Reporting Structure:

Direct report: Owner / CEO — for all audit findings, recommendations, scope decisions, and contract matters. This direct reporting line preserves the independence required for the audit function.

Cross-functional collaboration:

Works closely with the Operations Director, Clinical Director, PA Supervisor, and Medical Records Coordinator to gather information, request records, and communicate findings.

No direct reports:

The Compliance Auditor does not supervise staff. Findings are delivered to the CEO; remediation is implemented by the responsible department leader under their direction.

Core Responsibilities:

Internal chart audits. Conduct routine and targeted clinical chart audits across SACOT, SAIOP, Outpatient Therapy, Peer Support Services, and other agency service lines. Verify documentation completeness, billing-defensibility, and alignment with NC Medicaid Clinical Coverage Policies (8A, 8C, and others as applicable). MCO audit preparation and response. Prepare the agency for Clinical Quality Reviews (CQRs), post-payment audits, focused reviews, and other MCO-initiated audits across Alliance Health, Trillium Health Resources, AmeriHealth Caritas, Carolina Complete Health, NC Healthy Blue, UnitedHealthcare Community Plan, Vaya Health, and Partners. Coordinate document production, review responses for accuracy, and support the agency through the audit lifecycle. Documentation standards and gap identification . Identify systemic documentation gaps (CCA timeliness, PCP signature, treatment plan reviews, group note duplication, ratio compliance) and recommend corrective actions to leadership before they become external audit findings. Joint Commission and CARF accreditation support . Support the agency's Joint Commission pursuit by reviewing standards alignment across clinical, environmental, and human resources domains. Conduct mock surveys, identify gaps, and recommend policy or process changes. Policy and procedure review. Review agency policies and procedures against current NC DHSR rules, NC Medicaid

CCP, MCO

contract requirements, NCSAPPB and

NCBLCMHC

supervisor rules, HIPAA, 42 CFR Part 2, and accreditation standards. Recommend updates as regulations change. Credentialing audit support. Verify clinician licensure and credential status, supervision agreements, and payer-specific credentialing alignment. Identify mismatches between clinician credentials and the services they are billing. Service-line ratio and program compliance. Audit SACOT and SAIOP staffing ratios, group sizes, hours of operation, and program structure against NC Medicaid CCP 8A and related policies. Findings reports and corrective action plans . Produce written audit findings reports with prioritized recommendations and proposed corrective action plans. Track corrective action progress through closure. Quarterly executive briefings. Provide the CEO with quarterly compliance briefings summarizing audit activity, findings trends, regulatory changes, and accreditation readiness status. Required Qualifications Bachelor's degree in healthcare administration, nursing, or a related field; relevant certifications preferred. Minimum five (5) years of compliance, audit, quality assurance, or clinical operations experience in a North Carolina behavioral health agency, MCO, DHHS-licensed facility, or equivalent setting. Demonstrated, hands-on experience with NC Medicaid MCO audits — including Clinical Quality Reviews, post-payment audits, or focused reviews from Alliance, Trillium, AmeriHealth, or other NC MCOs. Experience surviving these audits, not just reading about them. Working knowledge of NC Medicaid Clinical Coverage Policies, particularly CCP 8A (substance use services) and CCP 8C (outpatient therapy). Working knowledge of NC DHSR licensure rules, NCSAPPB and

NCBLCMHC

supervisor requirements, HIPAA, and 42 CFR Part 2 confidentiality. Working knowledge of behavioral health service codes, group ratios, documentation timelines, and billing-defensible documentation standards. Strong written communication skills; ability to produce clear, organized, prioritized findings reports. Ability to work independently, manage own schedule, and meet deliverable timelines. Active LCAS, LCMHC, LCSW, RN, CCS, or equivalent NC-recognized credential strongly preferred (not strictly required for the auditor role). Successful completion of background check and any agency-required onboarding documentation. Preferred Qualifications Direct experience as a Joint Commission or CARF surveyor, or hands-on participation in a Joint Commission or CARF accreditation cycle as a clinical or compliance lead. Prior employment with a North Carolina MCO (Alliance, Trillium, AmeriHealth, etc.) on the clinical, audit, or quality side. Certified in Healthcare Compliance (CHC) or Healthcare Privacy Compliance (CHPC). Prior experience auditing across multiple BH service lines (SACOT, SAIOP, OPT, Peer Support, Mobile Crisis, Tailored Care Management). Familiarity with the Checkpoint EHR and other NC behavioral health EHR systems. Auditor Independence To preserve the integrity of the audit function, the Compliance Auditor reports directly to the CEO and operates independently of the operational and clinical leadership whose work is being audited. The Compliance Auditor does not have operational decision-making authority, does not supervise agency staff, and does not own remediation of identified findings. The auditor's role is to identify and recommend; remediation is owned by the responsible department leader under the direction of the CEO.

Pay:

$500.00

• $1,000.

00 per week People with a criminal record are encouraged to apply

Work Location:

Hybrid remote in Raleigh, NC 27634