MEDICAL/HEALTH CARE PROGRAM ANALYST
Requisition No:
809399 Agency:
Agency for Health Care Administration Working Title:
68064697 - MEDICAL/HEALTH CARE PROGRAM ANALYST Position Number:
68064697 Salary:
$1,742.
64 to $1,882.
05 biweekly Posting Closing Date:
08/18/2023 Agency Overview:
The Agency for Health Care Administration is Florida's chief health policy and planning entity.
The Agency is responsible for administering the Florida Medicaid program, the licensure and regulation of nearly 50,000 health care facilities, and empowering consumers through health care transparency initiatives.
Under the direction of Agency Secretary Jason Weida, the Agency is focused on advancing Governor DeSantis' vision for Florida's health care system to be the most cost-effective, transparent, and high-quality health care system in the nation.
Current Agency initiatives include implementing Florida's groundbreaking Canadian Prescription Drug Importation Program, overhauling Florida's healthcare technological ecosystem, and increasing insight in the cost of health care services.
Agency Objectives:
HIGH QUALITY Emphasizing quality in all that we do to improve health outcomes, always putting the individual first.
TRANSPARENT Supporting initiatives that promote transparency and empower consumers in making well informed healthcare decisions.
COST-EFFECTIVE Leveraging Florida's buying power in delivering high quality care at the lowest cost to taxpayers.
Position Overview:
This is a full-time career service position, with regularly scheduled hours of Monday-Friday 8:
00 a.
m.
to 5 p.
m.
This position may involve travel related activities from 1-15%.
The Medical Health Care Program Analyst will be hired at the salary of $1,742.
64 to $1,882.
05 biweekly.
The Agency requires background and fingerprint screening as a condition of employment.
The Florida Medicaid program is one of the five largest in the country and has an estimated $30 billion annual budget.
Each month Florida Medicaid covers medical services for almost 4 million recipients.
To most effectively serve this large patient population, one of the Agency goals is to ensure fewer budgeted dollars are lost to fraud, abuse, and waste.
The Bureau of Medicaid Program Integrity (MPI) does this specifically through audits and investigations of healthcare providers, including managed care plans, suspected of engaging in fraudulent or abusive behavior, as well as overpayment recoveries, administrative sanctions, and the referral of suspected fraud or other criminal violations for law enforcement investigation.
This Medical Health Care Program Analyst position will support the fraud and abuse prevention efforts within the Bureau of Medicaid Program Integrity.
MPI is organized by the functions that fall within the Bureau's responsibility:
Fraud and Abuse Detection, Prevention, Overpayment Recovery, and Managed Care oversight.
MPI operates with dynamic and fast-paced units that work closely with one another to serve the overall bureau mission.
Resolving the complexity and scope of fraudulent and abusive behavior in the Florida Medicaid program, these units work within the current framework while constantly seeking new and innovative strategies, methods, and technologies to fight fraud, abuse, and waste.
To do this, these highly collaborative and innovative units rely on teams with diverse educational and experience backgrounds.
A candidate selected for a position with an investigative unit (Detection and Prevention) will be responsible for conducting investigations, writing summary reports, and making referrals to other entities involving Medicaid providers in accordance with state and federal rules, laws, and statutes.
A candidate selected for a position with an audit unit (Overpayment Recovery or Managed Care) will be responsible for conducting audits, writing summary reports, and issuing audit reports in accordance with state and federal rules, laws, and statutes.
The selected candidate will also be responsible for working collaboratively with other MPI operational units and participating in special projects.
The candidate will be responsible for utilizing open-source and proprietary resources to conduct the audits and investigations and related administrative actions, as well as monitoring and tracking the associated case status.
Successful candidates must demonstrate the working knowledge and experience specifically related to fraud prevention programs, compliance assessment, and report writing in the investigative and audit processes.
This position requires a broad array of knowledge and experience specifically related to fraud prevention programs, compliance assessment, legal analysis, and the investigative process as well as a desire to innovate.
The selected candidate will assist in conducting investigations related to fraud, abuse, and waste through research and analysis of complex health and business-related data.
Included in the functions of this position are activities such as:
o Utilizing open-source and proprietary resources to conduct investigations and related administrative actions, as well as monitoring and tracking the associated case status.
o Preparing referrals to law enforcement entities, Medicaid health plans and other partners.
o Identifying, analyzing, and interpreting trends or patterns in data sets, as well as other investigative and research tools.
o Collaborating with team members on projects and assignments.
o Conducting audits and compliance reviews in accordance with state and federal rules, laws, and statutes.
Benefits of Working for the State of Florida:
Working for the State of Florida is more than a paycheck.
The State's total compensation package for employees features a highly competitive set of employee benefits including:
o State Group Insurance Coverage Options, including health, life, dental, vision, and other supplemental insurance options; o Flexible Spending Accounts; o State of Florida retirement options, including employer contributions; o Generous annual and sick leave benefits; o 9 paid holidays a year and 1 Personal Holiday each year; o Career advancement opportunities; o Tuition waiver for courses offered by Florida's nationally ranked State University System ; o Training and professional development opportunities; o And more! For a more complete list of benefits, please visit https:
//www.
mybenefits.
myflorida.
com/.
For more information, please view MPI's section of Florida's Efforts to Control Medicaid Fraud and Abuse FY 2020-2021 located at:
http:
//ahca.
myflorida.
com/MCHQ/MPI/docs/FraudReports/FraudReport2020-21.
pdf.
KNOWLEDGE, SKILLS, AND ABILITIES o Ability to solve problems and make decisions based on available information.
o Ability to execute projects and assignments timely and accurately within a fast-paced environment.
o Ability to conduct investigations, coordinate investigative activities, and accurately document the result of an investigation.
o Ability to conduct fact finding research.
o Ability to work independently.
o Ability to communicate effectively verbally and in writing.
o Ability to review and comprehend applicable federal and state laws, rules, policies, and regulations related to health care and enforcement activities.
o Ability to demonstrate proficiency using Microsoft features including, Word, Excel, Outlook, and Edge.
o Knowledge of the Florida Medicaid Program.
o Knowledge of research or investigative principles, practices, and techniques.
o Possess investigative skills, research skills, written and oral communication skills, and organizational skills.
MINIMUM QUALIFICATIONS REQUIREMENTS o Two years of investigative, enforcement, health care, or professional experience in a position within an educational, regulatory, or oversight setting.
Preference will be given to candidates with a bachelor's degree or higher from an accredited college or university, particularly in a related field such as:
health law, health science, criminology, criminal justice, or a substantially similar discipline.
Preference will be given to candidates with a program integrity related professional certification, such as:
Certified Fraud Examiner; Accredited Healthcare Fraud Investigator; Certified Financial Crimes Investigator; Certified Insurance Fraud Investigator; or Certified Compliance and Ethics Professional.
LICENSURE, CERTIFICATION, OR REGISTRATION REQUIREMENTS N/A CONTACT:
HELEN GUNN (850) 412-4626 The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.
Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735).
Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.
The State of Florida supports a Drug-Free workplace.
All employees are subject to reasonable suspicion drug testing in accordance with Section 112.
0455, F.
S.
, Drug-Free Workplace Act.
VETERANS' PREFERENCE.
Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans' Preference will receive preference in employment for Career Service vacancies and are encouraged to apply.
Certain service members may be eligible to receive waivers for postsecondary educational requirements.
Candidates claiming Veterans' Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code.
Veterans' Preference documentation requirements are available by clicking here.
All documentation is due by the close of the vacancy announcement.
Recommended Skills Administration Auditing Certified Compliance And Ethics Professional Certified Fraud Examiner Communication Coordinating Estimated Salary: $20 to $28 per hour based on qualifications.
809399 Agency:
Agency for Health Care Administration Working Title:
68064697 - MEDICAL/HEALTH CARE PROGRAM ANALYST Position Number:
68064697 Salary:
$1,742.
64 to $1,882.
05 biweekly Posting Closing Date:
08/18/2023 Agency Overview:
The Agency for Health Care Administration is Florida's chief health policy and planning entity.
The Agency is responsible for administering the Florida Medicaid program, the licensure and regulation of nearly 50,000 health care facilities, and empowering consumers through health care transparency initiatives.
Under the direction of Agency Secretary Jason Weida, the Agency is focused on advancing Governor DeSantis' vision for Florida's health care system to be the most cost-effective, transparent, and high-quality health care system in the nation.
Current Agency initiatives include implementing Florida's groundbreaking Canadian Prescription Drug Importation Program, overhauling Florida's healthcare technological ecosystem, and increasing insight in the cost of health care services.
Agency Objectives:
HIGH QUALITY Emphasizing quality in all that we do to improve health outcomes, always putting the individual first.
TRANSPARENT Supporting initiatives that promote transparency and empower consumers in making well informed healthcare decisions.
COST-EFFECTIVE Leveraging Florida's buying power in delivering high quality care at the lowest cost to taxpayers.
Position Overview:
This is a full-time career service position, with regularly scheduled hours of Monday-Friday 8:
00 a.
m.
to 5 p.
m.
This position may involve travel related activities from 1-15%.
The Medical Health Care Program Analyst will be hired at the salary of $1,742.
64 to $1,882.
05 biweekly.
The Agency requires background and fingerprint screening as a condition of employment.
The Florida Medicaid program is one of the five largest in the country and has an estimated $30 billion annual budget.
Each month Florida Medicaid covers medical services for almost 4 million recipients.
To most effectively serve this large patient population, one of the Agency goals is to ensure fewer budgeted dollars are lost to fraud, abuse, and waste.
The Bureau of Medicaid Program Integrity (MPI) does this specifically through audits and investigations of healthcare providers, including managed care plans, suspected of engaging in fraudulent or abusive behavior, as well as overpayment recoveries, administrative sanctions, and the referral of suspected fraud or other criminal violations for law enforcement investigation.
This Medical Health Care Program Analyst position will support the fraud and abuse prevention efforts within the Bureau of Medicaid Program Integrity.
MPI is organized by the functions that fall within the Bureau's responsibility:
Fraud and Abuse Detection, Prevention, Overpayment Recovery, and Managed Care oversight.
MPI operates with dynamic and fast-paced units that work closely with one another to serve the overall bureau mission.
Resolving the complexity and scope of fraudulent and abusive behavior in the Florida Medicaid program, these units work within the current framework while constantly seeking new and innovative strategies, methods, and technologies to fight fraud, abuse, and waste.
To do this, these highly collaborative and innovative units rely on teams with diverse educational and experience backgrounds.
A candidate selected for a position with an investigative unit (Detection and Prevention) will be responsible for conducting investigations, writing summary reports, and making referrals to other entities involving Medicaid providers in accordance with state and federal rules, laws, and statutes.
A candidate selected for a position with an audit unit (Overpayment Recovery or Managed Care) will be responsible for conducting audits, writing summary reports, and issuing audit reports in accordance with state and federal rules, laws, and statutes.
The selected candidate will also be responsible for working collaboratively with other MPI operational units and participating in special projects.
The candidate will be responsible for utilizing open-source and proprietary resources to conduct the audits and investigations and related administrative actions, as well as monitoring and tracking the associated case status.
Successful candidates must demonstrate the working knowledge and experience specifically related to fraud prevention programs, compliance assessment, and report writing in the investigative and audit processes.
This position requires a broad array of knowledge and experience specifically related to fraud prevention programs, compliance assessment, legal analysis, and the investigative process as well as a desire to innovate.
The selected candidate will assist in conducting investigations related to fraud, abuse, and waste through research and analysis of complex health and business-related data.
Included in the functions of this position are activities such as:
o Utilizing open-source and proprietary resources to conduct investigations and related administrative actions, as well as monitoring and tracking the associated case status.
o Preparing referrals to law enforcement entities, Medicaid health plans and other partners.
o Identifying, analyzing, and interpreting trends or patterns in data sets, as well as other investigative and research tools.
o Collaborating with team members on projects and assignments.
o Conducting audits and compliance reviews in accordance with state and federal rules, laws, and statutes.
Benefits of Working for the State of Florida:
Working for the State of Florida is more than a paycheck.
The State's total compensation package for employees features a highly competitive set of employee benefits including:
o State Group Insurance Coverage Options, including health, life, dental, vision, and other supplemental insurance options; o Flexible Spending Accounts; o State of Florida retirement options, including employer contributions; o Generous annual and sick leave benefits; o 9 paid holidays a year and 1 Personal Holiday each year; o Career advancement opportunities; o Tuition waiver for courses offered by Florida's nationally ranked State University System ; o Training and professional development opportunities; o And more! For a more complete list of benefits, please visit https:
//www.
mybenefits.
myflorida.
com/.
For more information, please view MPI's section of Florida's Efforts to Control Medicaid Fraud and Abuse FY 2020-2021 located at:
http:
//ahca.
myflorida.
com/MCHQ/MPI/docs/FraudReports/FraudReport2020-21.
pdf.
KNOWLEDGE, SKILLS, AND ABILITIES o Ability to solve problems and make decisions based on available information.
o Ability to execute projects and assignments timely and accurately within a fast-paced environment.
o Ability to conduct investigations, coordinate investigative activities, and accurately document the result of an investigation.
o Ability to conduct fact finding research.
o Ability to work independently.
o Ability to communicate effectively verbally and in writing.
o Ability to review and comprehend applicable federal and state laws, rules, policies, and regulations related to health care and enforcement activities.
o Ability to demonstrate proficiency using Microsoft features including, Word, Excel, Outlook, and Edge.
o Knowledge of the Florida Medicaid Program.
o Knowledge of research or investigative principles, practices, and techniques.
o Possess investigative skills, research skills, written and oral communication skills, and organizational skills.
MINIMUM QUALIFICATIONS REQUIREMENTS o Two years of investigative, enforcement, health care, or professional experience in a position within an educational, regulatory, or oversight setting.
Preference will be given to candidates with a bachelor's degree or higher from an accredited college or university, particularly in a related field such as:
health law, health science, criminology, criminal justice, or a substantially similar discipline.
Preference will be given to candidates with a program integrity related professional certification, such as:
Certified Fraud Examiner; Accredited Healthcare Fraud Investigator; Certified Financial Crimes Investigator; Certified Insurance Fraud Investigator; or Certified Compliance and Ethics Professional.
LICENSURE, CERTIFICATION, OR REGISTRATION REQUIREMENTS N/A CONTACT:
HELEN GUNN (850) 412-4626 The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.
Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735).
Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.
The State of Florida supports a Drug-Free workplace.
All employees are subject to reasonable suspicion drug testing in accordance with Section 112.
0455, F.
S.
, Drug-Free Workplace Act.
VETERANS' PREFERENCE.
Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans' Preference will receive preference in employment for Career Service vacancies and are encouraged to apply.
Certain service members may be eligible to receive waivers for postsecondary educational requirements.
Candidates claiming Veterans' Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code.
Veterans' Preference documentation requirements are available by clicking here.
All documentation is due by the close of the vacancy announcement.
Recommended Skills Administration Auditing Certified Compliance And Ethics Professional Certified Fraud Examiner Communication Coordinating Estimated Salary: $20 to $28 per hour based on qualifications.
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