68063500 - inspector specialist - Miami, United States - State of Florida

Description

Requisition No:

Agency: Agency for Health Care Administration

Working Title: INSPECTOR SPECIALIST

Pay Plan: Career Service

Position Number:

Salary: $1, $1,930.60 biweekly

Posting Closing Date: 05/16/2024

Total Compensation Estimator Tool

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.

Position Overview:

This is a full-time career service position, with regularly scheduled hours which are typically Monday-Friday 8:00 a.m. to 5 p.m. This position is being hired at the rate of $1, $48.00 (CAD) = $1, $1, $48.00 (CAD) = $1,930.60. This position may involve travel related activities from 1-10%. The Agency requires background and fingerprint screening as a condition of employment.

All applicants selected for interview will be required to perform a skills test that consist of proficient English reading and writing comprehension and an understanding about legal proceedings and investigations related to health care fraud and abuse.

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 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 operates with dynamic and fast-paced units that work closely with one another to serve the overall bureau mission. A candidate selected for a position with an investigative unit will be responsible for conducting investigations, writing summary reports, and making recommendations for referrals to other entities involving Medicaid providers in accordance with state and federal rules, laws, and statutes. The selected candidate will be expected to prepare, lead, and conduct pre-audit preparations, prepayment reviews, and project initiatives following the unit's approved protocols. The candidate should have experience in conducting interviews as well as investigations or other similar professional experience such as compliance monitoring or auditing sufficient to demonstrate the capability of analysis of Medicaid providers (billing information as well as other investigative findings) to determine violations of Medicaid policies and laws. The candidate should be able to determine overpayments or denial of payments to providers as required and to make appropriate referrals as required by approved protocols.

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 investigations, as well as monitoring and tracking the associated case status. Successful candidates must demonstrate working knowledge and experience specifically related to fraud prevention programs, compliance assessment, and report writing in the investigative and audit process.

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.

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:

KNOWLEDGE, SKILLS, AND ABILITIES

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

•Knowledge of Microsoft Word, Excel, PowerPoint, Outlook, and Internet Explorer.

•Knowledge of the Florida Medicaid Program.

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

•Ability to collect and analyze data.

•Ability to plan, design and conduct research studies.

•Ability to work independently.

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

•Ability to understand and apply applicable rules, regulations, policies, and procedures relating to research and analysis.

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

•Ability to communicate effectively verbally and in writing.

•Ability to establish and maintain effective working relationships with others.

Ability to travel for work related activities.

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

MINIMUM QUALIFICATIONS REQUIREMENTS

•Two years of investigative, enforcement, health care, or professional experience in a position within a regulatory, or oversight setting.

•One year of professional experience in planning, organizing, and coordinating work assignments.

•One year of professional use of computer software programs such as Word, Excel, PowerPoint, and Outlook.

•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

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 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 , 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.