Clinical Investigator Behavioral Health

Centene

Remote, US
Base: $56,200.00 - $101,000.00 py; bonus/equity: n...
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Investigating behavioral health fraud waste abuse trends
Verifying authorization for services and documentation
Analyzing provider billing patterns and codes
** Centene is seeking a Clinical Investigator in Behavioral Health to conduct reviews of medical records and claims to identify fraudulent and inappropriate billing practices, particularly in the behavioral health sector. This remote position requires a Master’s degree, clinical licensure, and experience in fraud, waste, and abuse investigations. **

Job Summary

  • Centene is seeking a Clinical Investigator to transform community health by identifying and preventing fraud, waste, and abuse among its 28 million members.
  • The role involves conducting retrospective and prepayment reviews of medical records to ensure the appropriateness of diagnosis and procedure codes supporting claims.
  • Candidates will collaborate with internal resources and Medical Directors to validate services against CMS guidelines and assist SIU investigators during interviews and negotiations.

Matching Summary

Match Score: 75

** Centene is seeking a Clinical Investigator in Behavioral Health to conduct reviews of medical records and claims to identify fraudulent and inappropriate billing practices, particularly in the behavioral health sector. This remote position requires a Master’s degree, clinical licensure, and experience in fraud, waste, and abuse investigations. **

Salary

Base: $56,200.00 - $101,000.00 per year; Bonus/Equity: Not specified; Benefits: Health insurance, 401K, stock purchase plans, tuition reimbursement, paid time off

Skills & Requirements

Must-have

  • Investigating behavioral health fraud waste abuse trends
  • Verifying authorization for services and documentation
  • Analyzing provider billing patterns and codes

Nice-to-have

  • Experience in provider education and managed care
  • Coding certification preferred
  • Ability to communicate complex audit results

Key Requirements

  • Master's Degree required
  • 2+ years clinical experience with independent license
  • 2+ years fraud waste and abuse experience
  • Behavioral health license (LMHC, LCSW, LMFT, LPC, LMHP, LIMHP)
  • Remote work eligibility

Work Rights

Not specified

Tailored Resume

Cover Letter