68900186 - OPS MEDICAL/HEALTH CARE PROGRAM ANALYST

Requisition No: 865599 

Agency: Agency for Health Care Administration

Working Title: 68900186 - OPS MEDICAL/HEALTH CARE PROGRAM ANALYST

 Pay Plan: Temp

Position Number: 68900186 

Salary:  $20.00 Hourly 

Posting Closing Date: 12/03/2025 

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This is a full-time Other Personal Services (OPS) position, with regularly scheduled hours of Monday-Friday 8:00 a.m. to 5:00 p.m.

This Medical Health Care Program Analyst (MHCPA) position will be filled at a non-negotiable rate of $20.00 per hour.

This position may involve travel-related activities from 1-15%. 

Successful completion of a criminal background investigation is a condition of employment. 

A good attendance record is essential for any individual in this position as the work involved occurs daily and is time sensitive.

The individual in this position is expected to report to work daily and on time.

The Florida Medicaid program is one of the five largest in the country and has an estimated $38 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 Office 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.

MPI is organized by the functions that fall within the Bureau’s responsibility: Operations, Data Detection, Investigations, 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 experienced backgrounds.

The candidate selected for this MHCPA position is responsible for providing compliance oversight of the Managed Care Plans (MCPs) participating in the Statewide Medicaid Managed Care program to ensure they are meeting program integrity requirements set forth in state and federal law, as well as the provisions of contract and Medicaid policy. 

This selected candidate assists with and advises on the planning, development and implementation of policies and procedures for MPI input related to managed care oversight regarding anti-fraud efforts. 

The selected candidate assists in developing and implementing a comprehensive anti-fraud program, including management of processes to oversee MCPs reporting requirements, managed care plans diligence in implementing anti-fraud processes, and the investigation of possible fraud, waste or abuse activity committed by the MCPs or their provider networks.

The selected candidate also participates in the intake, evaluation, and escalation of fraud referrals submitted by MCPs.

The selected candidate may be responsible for conducting audits, writing summary reports, and making referrals to other entities involving Medicaid providers or issuing audit reports in accordance with state and federal rules, laws, and statutes.

The selected candidate is responsible for conducting on-site visits to determine violations of Medicaid policies and is responsible for ensuring consistency and support regarding specific Prevention and Program Oversight (Field Operations) protocols.

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

The selected candidate will assist in conducting investigations/audits related to fraud, abuse, and waste through research and analysis of complex health and business-related data. 

Included in the functions of this MHCPA 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.

•Issuing audit reports or preparing referrals to law enforcement or other entities involving Medicaid providers.

•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.

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 Other Personal Services (OPS) employees features a highly competitive set of employee benefits including:

•              No state income tax for residents of Florida;

•              State Group Insurance coverage options (must meet eligibility requirements), including health, life, dental, vision, and other supplemental insurance options;

•              Savings & Spending Accounts;

•              401 (a) FICA Alternative Plan administered through VALIC (tax deferred Retirement Savings Plan);

•              Participation in the Florida Deferred Compensation Plan (457b)

For a more complete list of benefits and eligibility requirements, visit www.mybenefits.myflorida.com.

What is OPS employment?

OPS employment is a temporary employer/employee relationship used for accomplishing short term or intermittent tasks.  OPS employees are at-will employees and are subject to actions such as pay changes, changes to work assignment, and terminations at the pleasure of the agency head or designee.

OPS employees do not serve probationary periods or become permanent in their positions because they serve at the pleasure of the agency head.

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 demonstrate proficiency using Microsoft Word, Excel, Outlook, PowerPoint, SharePoint.

•Ability to travel with or without accommodation.

•Ability of strong research skills, written and oral communication skills, and organizational skills.

•Knowledge of the Florida Medicaid Program.

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

MINIMUM QUALIFICATIONS REQUIREMENTS

•Two years of experience in compliance enforcement, investigative, oversight, regulatory or health care services setting.

•An associate’s degree from an accredited college or university can substitute on a year for year basis in a related field such as health law, health science, health services administration, business administration, public administration, sociology, criminology, 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; Certified Compliance and Ethics Professional, or other relevant certification, such as: Project Management Professional.

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.