A health services organization in Maitland, Florida is seeking a Fee Schedule Auditor to support managed care operations. This hybrid role focuses on auditing fee schedules, resolving reimbursement discrepancies, and helping maintain payer compliance across Medicare, Medicaid, and commercial plans.
About the Opportunity:
- Shift: Day shift
- Schedule: Monday to Friday
- Hours: Standard business
- Setting: Hybrid (Monday to Wednesday onsite; Thursday and Friday are remote)
Responsibilities:- Audit and reconcile fee schedules against payer contracts, allowable amounts, and internal charge masters
- Identify discrepancies between billed charges, contracted rates, and actual reimbursements
- Collaborate with coding, billing, and contracting teams to resolve fee schedule errors and underpayments
- Maintain and update fee schedule databases to reflect contract changes, CMS updates, and new payer agreements
- Prepare audit reports and present findings to managed care leadership
Qualifications:- 3 to 5 years of experience in behavioral health or substance use billing, including IOP and OTP services
- Experience with code scrubbing, claims editing, denial management, or appeals processing
- Demonstrated ability to identify coding errors, unbundling issues, and claim-level deficiencies
- Experience managing and resolving denials and appeals with Medicare, Medicaid, and commercial payers
- Strong knowledge of CPT and HCPCS coding and reimbursement methodologies applicable to substance use services
Desired Skills:- Familiarity with Medicare bundled payments, Medicaid behavioral health carve-outs, and commercial mental health parity compliance
- Proficiency in Google Suite or similar data analysis tools
- CPC, CPMA, CPB, or similar AAPC/AHIMA certification
- Strong analytical and problem-solving skills with high attention to detail