Southwest Michigan Behavioral Health is looking for Compliance Analyst in Portage, MI.
This local job opportunity with ID 3828524087 is live since 2026-09-10 23:24:25.
Compliance Analyst
Southwest Michigan Behavioral Health • Portage, MI • Hybrid
Experience
2-5 years
Position Type
Non-Exempt
Industry
Healthcare
Travel
Minimal
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 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 REQUIREMENTS
Bachelor'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 SNAPSHOT
This 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 experienceClick on Apply
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