Behavioral Health Compliance & Audit Specialist

Central Florida Behavioral Health Network (CFBHN); Tampa (FL); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Competitive compensation

Paid time off

Job summary

Central Florida Behavioral Health Network (CFBHN) seeks a Behavioral Health Program Integrity Analyst to review Medicaid service justifications and related documentation, identifying irregularities and ensuring compliant billing practices.

The role collaborates with network providers, CFBHN staff, and state partners to promote accurate service authorization and adherence to Medicaid requirements. A master’s degree and healthcare compliance experience are preferred.

Qualifications

• Master’s degree in a related field.
• Three years of healthcare compliance, Medicaid, or related experience.
• Experience reviewing complex records and identifying irregularities.
• Strong written and verbal communication skills.
• Proficiency with Excel, OneDrive, SharePoint, AI tools, and databases.
• LCSW/LMFT/LMHC licensure is preferred.

Responsibilities

• Review Medicaid service justifications and supporting documentation from providers.
• Analyze atypical billing patterns and documentation issues referred through UM processes.
• Conduct detailed reviews of service records, claims docs, and authorization materials for contract/Medicaid compliance.
• Identify trends and potential billing compliance concerns.
• Prepare written findings, summaries, recommendations, and communications.
• Coordinate with UM, Quality Management, Compliance, Provider Relations, and Contract Management staff.
• Assist in developing monitoring tools, audit protocols, and risk-based reviews.
• Track investigations, referrals, and corrective actions.
• Participate in provider education on documentation standards and billing requirements.
• Maintain confidentiality of protected health information.
• Support audits, state reviews, and internal monitoring activities.
• Perform other related duties as assigned.

Skills

Analytical skills

Organizational skills

Written communication

Critical thinking

Investigative skills

Education

Master’s degree (healthcare administration / public admin / business / accounting / finance)

Tools

Microsoft Excel

OneDrive

SharePoint

Artificial Intelligence tools

Database applications

Job description

Central Florida Behavioral Health Network (CFBHN) seeks a Behavioral Health Program Integrity Analyst to review Medicaid service justifications and related documentation, identifying irregularities and ensuring compliant billing practices.

The role collaborates with network providers, CFBHN staff, and state partners to promote accurate service authorization and adherence to Medicaid requirements. A master’s degree and healthcare compliance experience are preferred.