68900289 - OPS MEDICAL/HEALTH CARE PROGRAM ANALYST

Position Overview

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

Responsibilities

• Provide 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.
• Conduct investigations into possible fraud or abuse committed by the MCPs or their provider networks.
• Conduct investigations/audits, visiting providers, identifying overpayments, writing investigative summary reports, and making recommendations for referrals to other entities involving Medicaid providers or issuing audit reports in accordance with state and federal rules, laws, and statutes.
• Collaborate with other MPI operational units and regulatory agencies as well as participate in joint data-driven field initiatives and special projects.
• Utilize open-source and proprietary resources to conduct investigations/audits and related administrative actions, as well as monitor and track the associated case status.
• Issue audit reports or prepare referrals to law enforcement or other entities involving Medicaid providers.
• Identify, analyze, and interpret trends or patterns in data sets, as well as other investigative and research tools.
• Assign and deactivate user accounts and access privileges in FACTS, prepare and submit operational, managerial, and ad-hoc reports extracted from FACTS data, and inform users of changes, trends, developments, and updates through written and verbal forms of communication and training.
• Conduct payment restriction reviews in accordance with state and federal rules, laws, and statutes.

Qualifications

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

Skills

• 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 Edge.

Benefits

• 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)

Contact Information

Contact: Helen Gunn
Phone: 850-412-4626

Background Screening

The Agency requires background and fingerprint screening as a condition of employment.