MEDICAL/HEALTH CARE PROGRAM ANALYST

Requisition No: 842575

Agency: Agency for Health Care Administration

Working Title: 68064378 - MEDICAL/HEALTH CARE PROGRAM ANALYST

Pay Plan: Career Service

Position Number: 68064378

Salary: $1,794.92 Biweekly

Posting Closing Date: 12/19/2024

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This is a full-time career service position, with regularly scheduled hours of Monday-Friday 8:00 am to 5 pm.

The Medical Health Care Program Analyst position will be filled at the rate of $1,794.92 biweekly and is non-negotiable.

This position may involve travel related activities from 1-75%.

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 $35 billion annual budget.

Each month Florida Medicaid covers medical services for almost 4 million recipients.

To 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 Medicaid providers, including managed care plans.

MPI also imposes administrative sanctions for program violations and refers suspected fraud or other criminal violations to appropriate law enforcement agencies for further investigation.

MPI operates with dynamic and fast-paced units that work closely together to serve the overall bureau mission.

MPI units are responsible for developing novel methods and innovative solutions necessary to address the complexity and scope of fraudulent and abusive behavior in the Florida Medicaid program.

These highly collaborative units rely on teams with diverse educational and experience backgrounds.

This Medical Health Care Program Analyst position will support the fraud and abuse prevention and detection efforts within the Bureau of Medicaid Program Integrity.

The candidate selected for this position will be responsible for conducting investigations, writing investigative summary reports, assisting with making referrals to other bureaus and entities, applying administrative sanctions and payment restrictions, and processing final orders involving Medicaid providers.

The selected candidate will need to demonstrate the ability to conduct investigations related to fraud, abuse, and waste through research and analysis of relevant legal documents, as well as complex health and business-related data.

The candidate will be responsible for utilizing open-source and proprietary resources to conduct these investigations and will be responsible for carrying out any related administrative actions.

This position requires a broad array of knowledge and experience specifically related to fraud prevention efforts, compliance assessment, legal analysis, and the investigative process, as well as a desire to innovate and a willingness to collaborate.

The selected candidate will be responsible for working collaboratively with other MPI operational units and participating in special projects.

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:
• State Group Insurance Coverage Options, including health, life, dental, vision, and other supplemental insurance options
• Flexible Spending Accounts
• State of Florida retirement options, including employer contributions
• Generous annual and sick leave benefits
• 9 paid holidays a year and 1 Personal Holiday each year
• Career advancement opportunities
• Tuition waiver for courses offered by Florida's nationally ranked State University System
• Training and professional development opportunities
• And more!

For more information on MPI, please visit MPI at: http://ahca.myflorida.com/MCHQ/MPI/index.shtml

KNOWLEDGE, SKILLS, AND ABILITIES

Ability to solve problems and make decisions based on available information.

Ability to execute projects and assignments timely and accurately within a fast-paced environment.

Ability to conduct investigations, coordinate investigative activities, and accurately document the result of an investigation.

Ability to conduct fact finding research.

Ability to work independently.

Ability to communicate effectively verbally and in writing.

Ability to review and comprehend applicable federal and state laws, rules, policies, and regulations related to health care and enforcement activities.

Ability to travel with or without accommodations.

Knowledge of the Florida Medicaid Program.

Knowledge of Microsoft features including Word, Excel, Outlook, and Internet Explorer.

Knowledge of research or investigative principles, practices, and techniques.

Possess investigative skills, research skills, written and oral communication skills, and organizational skills.

MINIMUM QUALIFICATIONS REQUIREMENTS

Two years professional work experience in a position with duties related to prevention, detection, or investigation of fraud, abuse, or waste in health care, and/or the requisite experience in a position within a regulatory, health services, or similar professional 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.

Professional or nonprofessional experience can substitute on a year-for-year basis for the preferred education.

LICENSURE, CERTIFICATION, OR REGISTRATION REQUIREMENTS

N/A

CONTACT:HELEN GUNN 850-412-4626

BACKGROUND SCREENING

It is the policy of the Florida Agency for Health Care Administration that any applicant being considered for employment must successfully complete a State and National criminal history check as a condition of employment before beginning employment, and, if applicable, also be screened in accordance with the requirements of Chapter 435, F.S., and Chapter 408, F.S. No applicant may begin employment until the background screening results are received, reviewed for any disqualifying offenses, and approved by the Agency. Background screening shall include, but not be limited to, fingerprinting for State and Federal criminal records checks through the Florida Department of Law Enforcement (FDLE) and Federal Bureau of Investigation (FBI) and may include local criminal history checks through local law enforcement agencies.

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.

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