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68064374 - MEDICAL/HEALTH CARE PROG ANALYST

Date: Oct 7, 2020

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Requisition No: 248261 

Agency: Agency for Health Care Administration

Working Title: 68064374 - MEDICAL/HEALTH CARE PROG ANALYST

Position Number: 68064374 

Salary:  $1,574.93 BI WEEKLY 

Posting Closing Date: 10/21/2020 

This is a full-time career service position, with regularly scheduled hours of Monday-Friday 8:00 a.m. to 5 p.m. This Medical Health Care Program Analyst position is anticipated to be filled at a rate of $40,948.18 per year. This position may involve travel related activities from 1-15%.  Successful completion of a criminal background investigation is a condition of employment.

 

The Florida Medicaid program is one of the five largest in the country and has an estimated $28 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.  To address the complexity and scope of fraudulent and abusive behavior in the Florida Medicaid program, these units are responsible for developing novel 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 statues. 

The selected candidate will also be responsible for working collaboratively with other MPI operational units and participating in special projects. The candidate will also 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. These units are seeking candidates with a broad array of knowledge and experience specifically related to fraud prevention programs, compliance assessment, and 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:

 

•Utilizing open-source and proprietary resources to conduct the investigations and related administrative actions, as well as monitoring and tracking the associated case status.

•Preparing referrals to law enforcement entities.

•Identifying, analyzing, and interpreting trends or patterns in data sets, as well as other investigative and research tools.

•Collaborating with team members on projects and assignments.

•Conducting payment restriction reviews in accordance with state and federal rules, laws, and statutes.

 

MPI provides a multitude of training opportunities for all MPI employees to enhance their professional growth.  This position offers an excellent array of benefits, including:  

                 

•Health insurance

•Life insurance

•Dental, vision and supplemental insurance     

•Retirement benefits   

•Vacation and sick leave

•Paid holidays

•Opportunities for career advancement

•Tuition waiver for public college courses

•Training opportunities

 

For more information, please view MPI's section of "Florida's Efforts to Control Medicaid Fraud and Abuse FY 2018-2019" located at: http://ahca.myflorida.com/MCHQ/MPI/docs/FraudReports/FraudReport2018-19.pdf

 

 

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.
  • 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:

  • 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.
     

CONTACT PERSON: Sterling Abney 850-412-4600

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.  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. 


Nearest Major Market: Tallahassee