Behavioral Health - Subject Matter Expert (SME)

Job Description: Position Summary

The Behavioral Health Audit Subject Matter Expert (SME) serves as the organization’s lead authority on behavioral health clinical guidelines, regulatory requirements, documentation standards, and audit methodology. This role provides expert-level guidance to audit teams, ensures clinical and regulatory accuracy across behavioral health audits, supports quality improvement, and helps drive operational consistency across programs.

Salary Range: $85,000 – $90,000 (based on experience, skills, and qualifications)
Location: 100% Remote (U.S.-based)

✈️ Up to 10% annual travel (for team meetings and limited client onsite engagements.)

For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits

• Responsibilities: Serve as the primary clinical and regulatory expert for behavioral health audit programs.
• Review audit findings to ensure accuracy, clinical appropriateness, and alignment with regulations.
• Develop and refine audit tools, scoring methodologies, and workflows.
• Perform secondary reviews on complex or escalated cases requiring clinical expertise.
• Identify quality gaps and recommend corrective actions.
• Ensure compliance with federal and state behavioral health requirements.
• Provide training and coaching to audit and clinical teams.
• Analyze audit trends and prepare reports for leadership.
• Support stakeholders with subject matter expertise and participate in remediation planning.

• Qualifications: Strong knowledge of behavioral health regulations, Medicaid/Medicare policy, and documentation standards.
• Excellent analytical, communication, and documentation skills.
• Education: Bachelor’s degree in healthcare administration, business, finance, or a related field.
• Experience: 3+ years in Behavioral Health services (mental health and substance use disorder treatment).
• Credentials (Preferred): CCS, RHIA, RHIT, CPC, RN, MSW – bonus points if you have multiple!

Preferred Qualifications

• Experience within payer or managed care settings.
• Prior experience as an auditor, quality lead, or compliance specialist.
• Familiarity with NCQA, URAC, CMS audit requirements.
• Experience developing audit tools or workflow optimization.

Core Competencies

• Clinical expertise in behavioral health.
• Strong regulatory interpretation and compliance knowledge.
• Critical thinking and decision-making.
• Effective communication across clinical and non-clinical audiences.
• Quality-focused and detail-oriented.
• Ability to mentor and influence cross-functional teams.

What We Offer:

✨ A fast-paced, innovative environment with a team of industry-leading experts .
✨ Hands-on experience with top-tier clients in the healthcare industry.
✨ Mentorship and career development programs to help you grow professionally.
✨ A strong culture of collaboration, support, and inclusivity .
✨ Competitive benefits package , including healthcare, vision, dental, and 401(k) options .

Ready to Take Your Career to the Next Level?

If you're looking for a rewarding and challenging opportunity where your expertise will be valued, your growth will be supported, and your contributions will make a difference— apply today and become part of the EXL team!