Behavioral Health Compliance & Billing Integrity Analyst

Central Florida Behavioral Health Network Inc; Palm Harbor (FL); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Paid time off

Benefits package

Job summary

Central Florida Behavioral Health Network Inc. seeks a Behavioral Health Program Integrity Analyst to review Medicaid service justifications and supporting documentation from network service providers, and to analyze billing patterns for compliance with contractual and state requirements.

The role emphasizes detailed reviews, documentation integrity, and collaboration with UM, Quality Management, and Compliance teams, to identify trends and provide written findings and recommendations.

Qualifications

• Master’s degree in healthcare administration, public administration, business administration, accounting, finance, behavioral healthcare, or related field.
• 3 years of experience in healthcare compliance, Medicaid administration, utilization management, auditing, claims review, provider oversight, billing compliance, or related work.
• Experience reviewing complex records, data, documentation, or financial information and identifying irregularities.
• Strong analytical, organizational, and written communication skills.

Responsibilities

• Review Medicaid service justifications and supporting documentation submitted by network service providers.
• Analyze atypical billing patterns, utilization concerns, and provider documentation issues referred through UM processes.
• Conduct detailed reviews of service records, claims-related documentation, and authorization materials to determine compliance with contractual, Medicaid, and state requirements.
• Identify trends, patterns, and potential areas of concern related to billing practices, service documentation, and provider compliance.
• Prepare written findings, summaries, recommendations, and technical assistance communications.
• Coordinate with Utilization Management, Quality Management, Compliance, Provider Relations, and Contract Management staff regarding identified concerns.
• Assist in the development of monitoring tools, audit protocols, and risk-based review processes.
• Track investigations, referrals, corrective actions, and follow-up activities.
• Participate in provider education efforts related to documentation standards, billing requirements, and program integrity expectations.
• Maintain confidentiality of protected health information and sensitive investigative information.

Skills

Analytical thinking

Organizational skills

Written communication

Critical thinking

Communication

Education

Master’s degree in healthcare administration

Tools

Microsoft Excel

OneDrive

SharePoint

Artificial intelligence tools

Database applications

Job description

Central Florida Behavioral Health Network Inc. seeks a Behavioral Health Program Integrity Analyst to review Medicaid service justifications and supporting documentation from network service providers, and to analyze billing patterns for compliance with contractual and state requirements.

The role emphasizes detailed reviews, documentation integrity, and collaboration with UM, Quality Management, and Compliance teams, to identify trends and provide written findings and recommendations.