68063501 - MEDICAL/HEALTH CARE PROGRAM ANALYST

State of Florida•Orlando, FL

1d•Onsite

About The Position

This is a career service position located in the Orlando MPI field office, with regularly scheduled hours of Monday-Friday 8:00a.m. to 5:00 p.m. This Medical Health Care Program Analyst position is anticipated to be filled at a rate of $1,833.39 b/w and is non-negotiable. This position will involve travel-related activities from 1-75%. Successful completion of a criminal background investigation is 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. All applicants selected for interview will be required to perform a skills assessment that consist of proficient English reading and writing comprehension and an understanding about legal proceedings and investigations related to health care fraud and abuse. MPI operates with dynamic and fast-paced units that work closely together to serve the overall mission of the Bureau. The selected candidate will be responsible for conducting investigations/audits, visiting providers, identifying overpayments, initiating payment restrictions, writing summary reports, and making referrals to other entities involving Medicaid providers or issuing audit reports in accordance with state and federal rules, laws, and statutes. The selected candidate will also be responsible for working collaboratively with other MPI operational units, and leading and/or participating in special projects or project initiatives. The candidate will also be responsible for utilizing open-source and proprietary resources to conduct investigations and related administrative actions, as well as monitoring and tracking the associated case status. 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. 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. 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

Two years of professional or nonprofessional experience in a regulatory or health service setting.
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 Word, Excel, Outlook, PowerPoint, and SharePoint.
Ability to travel with or without accommodation.
Ability of strong research skills, written and oral communication skills, and organizational skills.
Knowledge of the Florida Medicaid Program.
Knowledge of research or investigative principles, practices, and techniques.

Nice To Haves

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; Certified Compliance and Ethics Professional, or other relevant certification, such as: Project Management Professional.
Preference will be given to candidates with professional experience in business, or information analysis.

Responsibilities

conducting investigations/audits
visiting providers
identifying overpayments
initiating payment restrictions
writing summary reports
making referrals to other entities involving Medicaid providers or issuing audit reports in accordance with state and federal rules, laws, and statutes
working collaboratively with other MPI operational units
leading and/or participating in special projects or project initiatives
utilizing open-source and proprietary resources to conduct investigations and related administrative actions, as well as monitoring and tracking the associated case status
conducting interviews
analysis of Medicaid providers (billing information as well as other investigative findings) to determine violations of Medicaid policies and laws
assisting in conducting investigations related to fraud, abuse, and waste through research and analysis of complex health and business-related data

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