Compliance Analyst

Compliance Analyst

Southwest Michigan Behavioral Health • Portage, MI • Hybrid

ABOUT THE COMPLIANCE ANALYST ROLE

SWMBH 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.

COMPENSATION

Minimum: $55,080.  Maximum: $74,520.  Starting pay is based on experience

COMPLIANCE ANALYST DUTIES & RESPONSIBILITIES

• Evaluate appropriateness of billed services, CPT coding, and documentation against SWMBH guidelines
• Evaluate E/M service levels and modifier usage; determine overpayments/underpayments
• Follow the audit timeline and protocol standards; help build the audit schedule
• Perform fieldwork and report audit results to the Director of Program Integrity & SIU
• Help create and maintain audit tools for the various provider types
• Analyze data to identify system risks and strengthen regulatory compliance
• Research issues and recommend policy/procedure improvements
• Support Auditing and Monitoring Plan development and follow-through
• Screen employees, contractors, vendors, and providers for program exclusions
• As assigned: support investigations, coordinate compliance training, prepare reports to MDHHS/OIG, or manage compliance meeting logistics

COMPLIANCE ANALYST REQUIREMENTS

• Bachelor's in business, behavioral healthcare, or related field, or equivalent healthcare experience
• 2–5 years healthcare experience (utilization management, billing, reimbursement, clinical, business office, risk management, or finance) preferred
• 1+ year auditing or healthcare compliance experience preferred
• Knowledge of Federal and State Medicaid PIHP mental health/substance abuse rules and regulations
• CHC certification preferred
• Strong oral/written communication, critical thinking, and organizational skills
• Ability to manage multiple projects and meet deadlines
• Ability to maintain strict confidentiality
• Working knowledge of Microsoft Office 365; project management software experience preferred
• Must support culturally competent, trauma-informed, person-centered practices

POSITION SNAPSHOT

• This role is Hybrid-eligible per SWMBH policy; requires frequent sitting, standing, and walking
• Occasional local travel to complete essential functions or attend related events
• Occasionally lift up to 20 lbs.
• Full benefits package; salary commensurate with experience

HOW TO APPLY

Ready 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 www.swmbh.org. Emailed resumes will not be accepted.