68063525 - MEDICAL/HEALTH CARE PROGRAM ANALYST

Requisition No: 875300 | Agency: Agency for Health Care Administration | Position Number: 68063525

About the Agency

The Agency for Health Care Administration (AHCA) 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. AHCA is focused on advancing Governor DeSantis’ vision for Florida’s health care system to be the most cost-effective, transparent, and high-quality health care system in the nation. The Medicaid program provides low-income families and individuals with access to health care.

About the Role

This is an exciting opportunity to help shape the quality of health care in Florida. We are seeking a Medical/Health Care Program Analyst to enhance the delivery of health care services through the Florida Medicaid Program. This position requires a candidate who is creative, flexible, innovative, and thrives in a fast-paced, team-based work environment. The role is located in the Bureau of Medicaid Program Finance (MPF), which manages and projects Florida’s $34.4 billion Medicaid Services budget, oversees financial reporting of the Agency’s contracted Medicaid health plans, calculates Medicaid reimbursement rates, and disburses supplemental payments to Medicaid providers.

Responsibilities

• Plan, develop, and implement cost reimbursement analysis activities.
• Assist in the planning, development, and implementation of Medicaid reimbursement policies and procedures.
• Develop and implement cost reimbursement informational and operational procedures and manuals.
• Assist in the planning, development, and implementation of procedures to audit data submitted by applicants for licensure to operate nursing homes and determine if applicants are adequately financed.
• Audit provider cost reports and establish provider reimbursement rates.
• Develop procedures to evaluate requests from providers for increases in reimbursement rates.
• Analyze and review nursing home provider budgeted cost reports and make appropriate adjustments to establish an interim budgeted rate.
• Set facility rates in accordance with Medicaid reimbursement plans and policies and applicable federal and state rules and regulations.
• Establish the initial FRVS asset base for new or replacement nursing home facilities.
• Identify the need for and obtain additional information and cost data from providers to set a facility’s initial rate.
• Prepare cost report computer input sheets for all provider preliminary desk audits.
• Forward the initial budgeted rate notices to the appropriate Medicaid offices and to the fiscal agent.
• Calculate depreciation/indexing recapture amounts and notify providers and appropriate bureaus within the Agency to collect any calculated recaptures.
• Coordinate all activities necessary for the semi-annual (or annual, if mandated) rate settings for all nursing home providers enrolled in the Medicaid program.
• Update facility rates as audit and licensure results are made available.
• Review and analyze requests from Medicaid providers for rate adjustments and determine if a rate increase should be authorized.
• Calculate and set rates for the settlement of Medicaid interim reimbursement rates when the initial cost report becomes available.
• Verify that all rate changes are made correctly by the fiscal agent, and retro-active payments or adjustments are made appropriately.
• Determine and update lease bonds and lease bonds alternative amounts for nursing facilities and review the lease bond alternative fund to assess adequacy of funding levels.
• Assist in preparing special reports and analyses on provider costs and the fiscal effect of the primary features of the nursing home cost reimbursement plan.
• Perform complex statistical and financial analyses of Medicaid provider costs in long-term care and acute care facilities to assess their impact on overall Medicaid costs.
• Assist in the development and compilation of various special management or provider cost comparisons from cost report data.
• Provide technical assistance and consultation to departmental staff, provider associations, and other organizations regarding policies and procedures for provider rate setting.
• Assist in the preparation of informational and educational material on Medicaid provider rate setting.
• Assist in the development and implementation of cost reimbursement rate setting training programs.
• Maintain up-to-date knowledge concerning the Florida Medicaid program, including pertinent statutes, Florida rules, regulations of the Department of Health and Human Services, provider manuals, and Medicaid billing procedures.
• Remain informed about Medicaid activities of the Agency for Health Care Administration and operations of the fiscal agent contractor.
• Maintain detailed knowledge of Medicaid financial and statistical information at both state and national levels.
• Maintain detailed knowledge of Medicare and other health care program cost reimbursement principles and the Medicaid cost reimbursement and rate setting methods of other states.
• Remain informed about health care cost containment issues on the local, state, and national level.
• Maintain detailed knowledge of accepted accounting and auditing principles, procedures, and techniques.
• Assist in the development of long-range plans for policy and procedures development, implementation, and monitoring of cost reimbursement rate setting and analysis activities.
• Assist in the development of plans and schedules for the review and analysis of the rate setting and analysis function, provider cost report monitoring, special projects, surveys, studies, and provider and staff training.
• Assist in developing plans for short-term cost reimbursement analysis activities including policy revision, analysis of cost report data, provider reimbursement issues, and other areas.
• Assist in the development of analysis goals, objectives, and priorities.
• Assist in the development of performance standards and criteria to measure the accomplishment of goals and objectives.
• Assist in planning, developing, and implementing policies and procedures for provider rate setting and rate analysis.
• Assist in developing rate setting manuals as appropriate for the application of cost reimbursement plans and principles of reimbursement.
• Assist in planning for and coordinating the implementation of rate setting policies and procedures with other staff in the Bureau of Medicaid Program Finance, the Bureau of Medicaid Contract Management, the fiscal agent contractor, other departmental offices, districts, providers, and provider associations.
• Assist in identifying and resolving any problems in the implementation of rate setting policy and procedure revisions.
• Review and analyze revisions to CMS Pub. 15-1, federal rules and regulations, and other related materials to determine their impact on rate setting policies and procedures.
• Review and analyze cost reports to determine common errors and provider difficulty in using cost report forms.
• Assist in the development of revisions to the cost report forms based on these analyses.
• Assist in the development and implementation of cost report forms designed for data entry and automated provider cost systems.
• Assist in the development and implementation of revised rate setting policies and procedures designed to increase the efficiency of the rate setting and analysis functions.
• Perform other duties and responsibilities as required.

Qualifications

This position requires a candidate with expertise in Medicaid reimbursement, cost analysis, and health care program policies. Knowledge of accepted accounting and auditing principles, Medicare, and other health care program cost reimbursement principles is essential.

Pay

Salary: $1,833.39 - $2,383.41 biweekly

Benefits

• Health insurance (individual and family coverage) for eligible employees
• Life insurance; $25,000 policy is free with the option to purchase additional life insurance
• Dental, vision, and supplemental insurance
• State of Florida retirement options, including employer contributions
• Ability to earn up to 104 hours of paid annual leave as a new employee
• Ability to earn up to 104 hours of sick leave annually
• Nine paid holidays and one personal holiday each year
• Opportunities for career advancement
• Tuition waivers (accepted by major Florida Colleges/universities)
• Student loan forgiveness opportunities (eligibility required)
• Training opportunities
• Flexible Spending Accounts
• Shared Savings Program for select medical services
• Lower copays for prescription drugs
• Health and Wellness discounts

Schedule

This position is located at the Headquarters in Tallahassee and is not a remote or telework position. Posting closing date: 08/25/2026.