Behavioral Health Program Integrity Analyst

CENTRAL FLORIDA BEHAVIORAL HEALTH NETWORK INC • Tampa, FL

5d • $63,000 - $69,000 • Onsite

About The Position

The Behavioral Health Program Integrity Analyst conducts reviews of Medicaid service justifications, documentation concerns, and atypical billing matters. The role supports CFBHN’s oversight responsibilities by identifying potential compliance issues, billing irregularities, documentation deficiencies, and patterns that may indicate program integrity concerns. The analyst collaborates with network service providers, CFBHN staff, and state partners to promote accurate billing, appropriate service authorization practices, and compliance with Medicaid and contractual requirements. The position involves analytical and investigative work; it does not provide clinical services, make medical necessity determinations, or require professional licensure.

This temporary, full-time position supports an important organizational initiative and is expected to continue for up to two years. CFBHN may modify, extend, or conclude the assignment as organizational needs evolve. The position offers competitive compensation, benefits, and paid time off, subject to organizational policies and benefit plan eligibility requirements.

Requirements

• Master’s degree in healthcare administration, public administration, business administration, accounting, finance, behavioral healthcare, or a related field.
• Three 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.
• Proficiency with Microsoft Excel, OneDrive, SharePoint, artificial intelligence tools, and database applications.
• Knowledge of healthcare compliance and Medicaid program requirements.
• Ability to evaluate documentation and data to identify inconsistencies, trends, and potential compliance concerns.
• Ability to conduct fact-based reviews and prepare objective written findings.
• Ability to interpret policies, contracts, regulations, and billing requirements.
• Ability to communicate effectively with provider organizations and internal stakeholders.
• Ability to maintain discretion and handle sensitive information appropriately.
• Strong critical-thinking and investigative skills.

Nice To Haves

• Experience with Florida Medicaid behavioral health services.
• Experience working with managed care organizations, managing entities, health plans, or healthcare provider organizations.
• Experience conducting audits, investigations, or compliance reviews.
• Certification related to compliance, fraud examination, auditing, healthcare quality, or investigations (e.g., CHC, CHPC, CFE, CPC, CHA).
• Licensure as LCSW, LMFT, or LMHC.

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 Utilization Management 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 concerns 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 developing monitoring tools, audit protocols, and risk-based review processes.
• Track investigations, referrals, corrective actions, and follow-up activities.
• Participate in provider education on documentation standards, billing requirements, and program integrity expectations.
• Maintain confidentiality of protected health information and sensitive investigative information.
• Support audits, state reviews, and internal monitoring activities as assigned.
• Perform other related duties as assigned.

Benefits

• Competitive compensation
• Benefits, subject to organizational policies and benefit plan eligibility requirements
• Paid time off, subject to organizational policies and benefit plan eligibility requirements

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level