OPS MEDICAL/HEALTH CARE PROGRAM ANALYST

at  The State of Florida

Requisition No: 840854
Agency: Agency for Health Care Administration
Working Title: 68900202 - OPS MEDICAL/HEALTH CARE PROGRAM ANALYST
Pay Plan: Temp
Position Number: 68900202
Salary: $19.69 - $20.00 Hourly
Posting Closing Date: 11/20/2024
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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 OPS position, with regularly scheduled hours of Monday-Friday 8:00 a.m. to 5 p.m.
This position may involve travel related activities from 1-15%.
The Agency requires background and fingerprint screening as a condition of employment.
This advertisement can be used to hire in the bureau for any of the open OPS Medical Heath Care Program Analyst positions and may have the opportunity to work with multiple units within the bureau.
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 5.5 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.
This OPS Medical Health Care Program Analyst position will support these efforts.
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.
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 statutes.
Working in one of the positions 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 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 discretion 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 features including, Word, Excel, Outlook, and Internet Explorer.
Ability to travel with or without accommodation.
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

One year of investigative, enforcement, health care, or professional experience in a position within a 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.

LICENSURE, CERTIFICATION, OR REGISTRATION REQUIREMENTS

N/A

Please refer the Job description for details