68063480 - INSPECTOR SPECIALIST

State of Florida

1d•Hybrid

About The Position

This is a full-time career service position with regularly scheduled hours typically Monday-Friday 8:00 a.m. to 5 p.m. The position has a Competitive Area Differential (CAD) and will be hired at $1,833.39 + $48.00 = $1,881.39 biweekly/non-negotiable. This position may involve travel related activities from 1-25%. The Agency requires background and fingerprint screening as a condition of employment. A good attendance record is essential for any individual in this position as the work involved occurs daily and is time sensitive. The individual in this position is expected to report to work daily and on time. All applicants selected for interview will be required to perform a skills test that consists of proficient English reading and writing comprehension and an understanding about legal proceedings and investigations related to health care fraud and abuse. 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 health care providers, including managed care plans, suspected of engaging in fraudulent or abusive behavior, as well as through overpayment recoveries, administrative sanctions, and referrals of suspected fraud or other criminal violations to law enforcement for investigation. MPI operates with dynamic and fast-paced units that work closely together to serve the overall mission of the Bureau. A candidate selected for a position with an investigative unit will be responsible for conducting investigations, visiting providers, identifying overpayments, writing investigative summary reports, and making recommendations for referrals to other entities involving Medicaid providers in accordance with state and federal rules, laws, and statutes. The selected candidate will be expected to prepare, lead, and conduct pre-audit preparations, prepayment reviews, and project initiatives following the unit’s approved protocols. The candidate should have experience in conducting interviews as well as investigations or other similar professional experience such as compliance monitoring or auditing sufficient to demonstrate the capability of analysis of Medicaid providers (billing information as well as other investigative findings) to determine violations of Medicaid policies and laws. The selected candidate will be required to collaborate with other MPI operational units and regulatory agencies as well as to participate in joint data driven field initiatives. The incumbent is responsible for conducting on-site visits to determine violations of Medicaid policies and is responsible for ensuring consistency and support regarding specific Prevention and Program Oversight (Field Operations) protocols. This position requires a broad array of knowledge and experience specifically related to fraud prevention programs, compliance assessment, legal analysis, and report writing in the investigative and audit 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. This position has been identified as mission essential. The incumbent in this position may be required to work during the weekend or on holidays. In addition, mission essential personnel will be required to work during disasters, to include but not limited to, work before, during and/or beyond normal work hours or days in the event of an emergency. Emergency work may involve the incumbent to work in another county or staffing location to assist other State Agencies with emergency work. Emergency duties may include, but are not limited to, responses to or threats involving any disaster or threat of disaster, man-made or natural.

Requirements

Proficient English reading and writing comprehension
Understanding about legal proceedings and investigations related to health care fraud and abuse
Two years of investigative, enforcement, health care, or professional experience in a position within a regulatory, or oversight setting
One year of professional experience in planning, organizing, and coordinating work assignments
One year of professional use of computer software programs such as Word, Excel, PowerPoint, and Outlook
Knowledge of research or investigative principles, practices, and techniques of research and analysis
Knowledge of Microsoft Word, Excel, PowerPoint, Outlook, and Internet Explorer
Knowledge of the Florida Medicaid Program
Ability to execute projects and assignments timely and accurately within a fast-paced environment
Ability to collect and analyze data
Ability to plan, design and conduct research studies
Ability to work independently
Ability to solve problems and make decisions based on available information
Ability to understand and apply applicable rules, regulations, policies, and procedures relating to research and analysis
Ability to conduct investigations, coordinate investigative activities, and accurately document the results of an investigation
Ability to communicate effectively verbally and in writing
Ability to establish and maintain effective working relationships with others
Ability to travel with or without accommodation
Possess investigative skills, research skills, written and oral communication skills, and organizational skills

Nice To Haves

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

Responsibilities

Conducting investigations
Visiting providers
Identifying overpayments
Writing investigative summary reports
Making recommendations for referrals to other entities involving Medicaid providers in accordance with state and federal rules, laws, and statutes
Prepare, lead, and conduct pre-audit preparations, prepayment reviews, and project initiatives following the unit’s approved protocols
Conducting interviews
Compliance monitoring or auditing
Analysis of Medicaid providers (billing information as well as other investigative findings) to determine violations of Medicaid policies and laws
Collaborate with other MPI operational units and regulatory agencies
Participate in joint data driven field initiatives
Conducting on-site visits to determine violations of Medicaid policies
Ensuring consistency and support regarding specific Prevention and Program Oversight (Field Operations) protocols
Assist in conducting investigations related to fraud, abuse, and waste through research and analysis of complex health and business-related data
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

Health insurance (i.e., individual and family coverage) to eligible employees
Life insurance: $25,000 policy is free plus 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 with the State of Florida
Ability to earn up to 104 hours of sick leave annually
Nine paid holidays and 1 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