Medical/health Care Program Analyst - Tallahassee, United States - State of Florida

Description

Requisition No: 825742

Agency:
Agency for Health Care Administration

Working Title:
MEDICAL/HEALTH CARE PROGRAM ANALYST

Pay Plan:
Career Service


Position Number:

Salary:
$1,742.64 biweekly

Posting Closing Date: 04/22/2024

Total Compensation Estimator Tool
This is a full-time career service position, with regularly scheduled hours of Monday-Friday 8:00 a.m. to 5 p.m. The Medical Health Care Program Analyst position is to be filled at a rate of $1,742.64 bi-weekly/non-negotiable. 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 $38 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.

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

The selected candidate will report to the Program Administrator, in the Bureau's Special Projects Unit.

The position incorporates all the functions that fall within the Bureaus' responsibility and works with the various units in MPI.

The incumbent will be responsible for the coordination of program activities while supporting the operations of unit and bureau administrative activities and is expected to work both independently and in a group setting to complete work assignments related to bureau needs.

This position will be privy to sensitive information and the incumbent is expected to maintain information in the strictest confidence.

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.

Addressing 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.

MPI's Detection and Prevention units are 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.

Overpayment Recovery and Managed Care units are responsible for conducting audits, writing summary reports, and issuing audit reports in accordance with state and federal rules, laws, and statues.

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.

MPI is 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.

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 a more complete list of benefits, please visit
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 features including Word, Excel, Outlook, PowerPoint, SharePoint.
• Knowledge of the Florida Medicaid Program.
• 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 experience as described above can substitute on a year-for-year basis for the preferred college education.
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.

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