Compliance AnalystSouthwest Michigan Behavioral Health • Portage, MI • Hybrid Experience 2-5 years Position Type Non-Exempt Industry Healthcare Travel Minimal ABOUT THE COMPLIANCE ANALYST ROLESWMBH is a $350 million governmental entity managing multiple Michigan Department of Community Health benefits management contracts across an eight-county region. As Compliance Analyst, you'll support the organization's program integrity and compliance functions by auditing SWMBH departments and the Provider network, performing excluded provider screenings, and helping detect and remediate inappropriate procedures or activities.COMPENSATIONMinimum: $55,080. Maximum: $74,520. Starting pay is based on experienceCOMPLIANCE ANALYST DUTIES & RESPONSIBILITIESEvaluate appropriateness of billed services, CPT coding, and documentation against SWMBH guidelinesEvaluate E/M service levels and modifier usage; determine overpayments/underpaymentsFollow the audit timeline and protocol standards; help build the audit schedulePerform fieldwork and report audit results to the Director of Program Integrity & SIUHelp create and maintain audit tools for the various provider typesAnalyze data to identify system risks and strengthen regulatory complianceResearch issues and recommend policy/procedure improvementsSupport Auditing and Monitoring Plan development and follow-throughScreen employees, contractors, vendors, and providers for program exclusionsAs assigned: support investigations, coordinate compliance training, prepare reports to MDHHS/OIG, or manage compliance meeting logisticsCOMPLIANCE ANALYST REQUIREMENTSBachelor's in business, behavioral healthcare, or related field, or equivalent healthcare experience2-5 years healthcare experience (utilization management, billing, reimbursement, clinical, business office, risk management, or finance) preferred1+ year auditing or healthcare compliance experience preferredKnowledge of Federal and State Medicaid PIHP mental health/substance abuse rules and regulationsCHC certification preferredStrong oral/written communication, critical thinking, and organizational skillsAbility to manage multiple projects and meet deadlinesAbility to maintain strict confidentialityWorking knowledge of Microsoft Office 365; project management software experience preferredMust support culturally competent, trauma-informed, person-centered practicesPOSITION SNAPSHOTThis role is Hybrid-eligible per SWMBH policy; requires frequent sitting, standing, and walkingOccasional local travel to complete essential functions or attend related eventsOccasionally lift up to 20 lbs.Full benefits package; salary commensurate with experienceHOW TO APPLYReady to join SWMBH as our next Compliance Analyst? Individuals of diverse racial, ethnic, and cultural backgrounds, including those with lived experience with behavioral health issues, along with bilingual candidates, are encouraged to apply. Apply online at . Emailed resumes will not be accepted.Compensation details: 0 Yearly SalaryPI804e112ea26f-8910
Not specified in the original listing.
Not specified in the original listing.
