A healthcare organization in Florida is seeking a Fee Schedule Auditor to join their team in Maitland. This hybrid role focuses on supporting accurate reimbursement, payer contract compliance, and revenue integrity for behavioral health and substance use services.
About the Opportunity:
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Schedule: Monday to Friday
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Setting: Hybrid (Monday to Wednesday in the office)
Responsibilities:
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Audit and reconcile fee schedules against payer contracts, allowable amounts, and internal charge masters for behavioral health and substance use service lines
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Identify discrepancies between billed charges, contracted rates, and actual reimbursements across payer types
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Collaborate with coding, billing, and contracting teams to resolve fee schedule errors and underpayments
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Maintain and update fee schedule databases to reflect contract changes, CMS updates, and new payer agreements
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Prepare audit reports and present findings to management
Qualifications:
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3 to 5 years of experience in Behavioral Health or Substance Use Billing, with a focus on Code Scrubbing, Claims Editing, Denial Management, or Appeals Processing
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Demonstrated ability to identify coding errors, unbundling issues, and claim-level deficiencies before or after submission
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Experience managing and resolving denials and appeals with Medicare, Medicaid, and commercial payers
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Strong knowledge of CPT and HCPCS coding and reimbursement methodologies applicable to substance use services
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Strong analytical and problem-solving skills with high attention to detail
Desired Skills:
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CPC, CPMA, CPB, or similar AAPC/AHIMA certification
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Experience with Medicare bundled payments and Medicaid behavioral health carve-outs
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Familiarity with commercial mental health parity compliance
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Proficiency in Google Suite or similar data analysis tools
