68900289 - OPS MEDICAL/HEALTH CARE PROGRAM ANALYST
State of Florida, Miami, FL, United States
Position Overview
This full‑time OPS position with a regular schedule Monday‑Friday 8:00 a.m.‑5 p.m. requires 1‑15% travel and is paid $20.00 per hour (non‑negotiable). The analyst supports fraud and abuse prevention within the Bureau of Medicaid Program Integrity (MPI), providing compliance oversight of Managed Care Plans (MCPs), conducting investigations, and collaborating with other MPI units and regulatory agencies.
Responsibilities
Provide compliance oversight of MCPs to ensure they meet state and federal program integrity requirements.
Conduct investigations and audits related to fraud, abuse, and waste, including on‑site provider visits, identification of overpayments, and preparation of investigative summary reports.
Issue audit reports or prepare referrals to law enforcement or other entities involving Medicaid providers.
Collaborate with MPI operational units and external regulatory agencies on joint data‑driven field initiatives and special projects.
Utilize open‑source and proprietary resources for investigations, monitor case status, and maintain accurate records in FACTS.
Manage user accounts and access privileges in FACTS, preparing operational, managerial, and ad‑hoc reports from FACTS data.
Conduct payment restriction reviews and ensure compliance with state and federal rules.
Analyze data sets to identify trends or patterns and support investigative and research tools.
Knowledge, Skills, and Abilities
Problem‑solving and decision‑making based on available information.
Execution of projects and assignments timely and accurately in a fast‑paced environment.
Conduct investigations, coordinate investigative activities, and document results.
Research fact‑finding and investigative principles, practices, and techniques.
Independent work and effective verbal and written communication.
Review and comprehend applicable federal and state laws, rules, policies, and regulations related to health care enforcement.
Proficiency with Microsoft Office (Word, Excel, Outlook) and Edge.
Travel with or without accommodations.
Knowledge of the Florida Medicaid Program.
Organizational skills and investigative, research, written, and oral communication skills.
Minimum Qualifications
At least two years of investigative, enforcement, health care, or professional experience in a regulatory or oversight setting.
Preference for a bachelor’s degree or higher from an accredited institution in health law, health science, criminology, criminal justice, or a substantially similar discipline.
Preference for candidates holding program integrity related certifications such as Certified Fraud Examiner, Accredited Healthcare Fraud Investigator, Certified Financial Crimes Investigator, Certified Insurance Fraud Investigator, or Certified Compliance and Ethics Professional.
Background Screening
Applicants must complete state and national criminal history checks, fingerprinting, and relevant local criminal history checks. Background screening results must be reviewed and approved before employment. Reasonable accommodations must be requested in advance.
Background screening results are required for employment under the Florida Agency for Health Care Administration policy.
Benefits
No state income tax for Florida residents.
State Group Insurance coverage options (health, life, dental, vision, and supplemental insurance).
Savings & Spending Accounts.
401(a) FICA Alternative Plan administered through VALIC.
Participation in the Florida Deferred Compensation Plan (457(b)).
Contact
Helen Gunn – 850‑412‑4626
Additional Information
The State of Florida supports a drug‑free workplace. Employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S.
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This full‑time OPS position with a regular schedule Monday‑Friday 8:00 a.m.‑5 p.m. requires 1‑15% travel and is paid $20.00 per hour (non‑negotiable). The analyst supports fraud and abuse prevention within the Bureau of Medicaid Program Integrity (MPI), providing compliance oversight of Managed Care Plans (MCPs), conducting investigations, and collaborating with other MPI units and regulatory agencies.
Responsibilities
Provide compliance oversight of MCPs to ensure they meet state and federal program integrity requirements.
Conduct investigations and audits related to fraud, abuse, and waste, including on‑site provider visits, identification of overpayments, and preparation of investigative summary reports.
Issue audit reports or prepare referrals to law enforcement or other entities involving Medicaid providers.
Collaborate with MPI operational units and external regulatory agencies on joint data‑driven field initiatives and special projects.
Utilize open‑source and proprietary resources for investigations, monitor case status, and maintain accurate records in FACTS.
Manage user accounts and access privileges in FACTS, preparing operational, managerial, and ad‑hoc reports from FACTS data.
Conduct payment restriction reviews and ensure compliance with state and federal rules.
Analyze data sets to identify trends or patterns and support investigative and research tools.
Knowledge, Skills, and Abilities
Problem‑solving and decision‑making based on available information.
Execution of projects and assignments timely and accurately in a fast‑paced environment.
Conduct investigations, coordinate investigative activities, and document results.
Research fact‑finding and investigative principles, practices, and techniques.
Independent work and effective verbal and written communication.
Review and comprehend applicable federal and state laws, rules, policies, and regulations related to health care enforcement.
Proficiency with Microsoft Office (Word, Excel, Outlook) and Edge.
Travel with or without accommodations.
Knowledge of the Florida Medicaid Program.
Organizational skills and investigative, research, written, and oral communication skills.
Minimum Qualifications
At least two years of investigative, enforcement, health care, or professional experience in a regulatory or oversight setting.
Preference for a bachelor’s degree or higher from an accredited institution in health law, health science, criminology, criminal justice, or a substantially similar discipline.
Preference for candidates holding program integrity related certifications such as Certified Fraud Examiner, Accredited Healthcare Fraud Investigator, Certified Financial Crimes Investigator, Certified Insurance Fraud Investigator, or Certified Compliance and Ethics Professional.
Background Screening
Applicants must complete state and national criminal history checks, fingerprinting, and relevant local criminal history checks. Background screening results must be reviewed and approved before employment. Reasonable accommodations must be requested in advance.
Background screening results are required for employment under the Florida Agency for Health Care Administration policy.
Benefits
No state income tax for Florida residents.
State Group Insurance coverage options (health, life, dental, vision, and supplemental insurance).
Savings & Spending Accounts.
401(a) FICA Alternative Plan administered through VALIC.
Participation in the Florida Deferred Compensation Plan (457(b)).
Contact
Helen Gunn – 850‑412‑4626
Additional Information
The State of Florida supports a drug‑free workplace. Employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S.
#J-18808-Ljbffr