68900188 - OPS GOVERNMENT ANALYST II

State of Florida • Tallahassee, FL

12d

About The Position

The Agency for Health Care Administration 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. This is a full-time OPS position, with regularly scheduled hours of Monday-Friday 8:00 a.m. to 5 p.m. This position is for candidates with Behavioral Health training and experience. This position is not a Data Analysis position. This position will be hired at $25.00 hourly and is non-negotiable. This position may involve travel-related activities from 1-15%. The Agency requires background and fingerprint screening as a condition of employment. This advertisement can be used to hire in the bureau for any of the open OPS Government Analyst II positions and may have the opportunity to work with multiple units within the bureau. 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 5.5 million recipients. To most 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 healthcare providers, including managed care plans. This OPS Government Analyst II position will support these efforts. MPI is organized by the functions that fall within the Bureau’s responsibility: Fraud and Abuse Detection, Prevention, Overpayment Recovery, and Managed Care oversight. MPI operates with dynamic and fast-paced units that work closely with one another to serve the overall bureau mission. A candidate selected for the OPS Government Analyst II position with an audit unit (Overpayment Recovery or Managed Care) will be responsible for conducting audits, writing summary reports, and issuing audit reports in accordance with state and federal rules, laws, and statutes. Key responsibilities include conducting data and programmatic analyses, performing desk audits, coordinating with internal staff and peer reviewers, and collaborating with attorneys to support and defend work products throughout the judicial process. Also, the candidate will support the work of other analysts by serving as a subject matter expert if necessary. MPI's Practitioner Care Unit, is seeking a candidate with Behavioral Health training and experience. The candidate will use professional expertise and knowledge as well as professional standards to conduct efficient, effective research, analysis, reviews, investigations, and audits, to determine violations of Medicaid policies, establish overpayments, and make referrals. Consult with staff to determine areas of concern and potential audit strategies to evaluate providers effectively and efficiently. Participate in on-site investigations where professional expertise is appropriate. Working in this position requires a broad array of knowledge and experience related to compliance assessment, legal analysis, and the investigative process as well as a desire to innovate. The selected candidate will assist in conducting investigations and audits 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 plan and conduct audits as well as monitoring and tracking the associated case status. •Preparing referrals to law enforcement and other 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. •Collaborating with peer reviewers.

Requirements

• One year of professional experience in health care within a service delivery, administrative, regulatory, or oversight 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 features including, Word, Excel, Outlook, and Internet Explorer.
• Ability to travel with or without accommodation.
• Knowledge of the Florida Medicaid Program.
• Knowledge of research or investigative principles, practices, and techniques.
• Possess investigative skills, research skills, written and oral communication skills, and organizational skills.

Nice To Haves

• 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: healthcare administration, psychology, social work, counseling, nursing or a substantially similar discipline.
• Preference will be given to candidates with Behavioral Health experience or training. Including professional licensure such as LMHC, LCSW, LMFT or Behavioral Analysis Certification.
• 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; or Certified Compliance and Ethics Professional.

Responsibilities

• Conducting audits
• Writing summary reports
• Issuing audit reports in accordance with state and federal rules, laws, and statutes
• Conducting data and programmatic analyses
• Performing desk audits
• Coordinating with internal staff and peer reviewers
• Collaborating with attorneys to support and defend work products throughout the judicial process
• Serving as a subject matter expert if necessary
• Conduct efficient, effective research, analysis, reviews, investigations, and audits, to determine violations of Medicaid policies, establish overpayments, and make referrals
• Consult with staff to determine areas of concern and potential audit strategies to evaluate providers effectively and efficiently
• Participate in on-site investigations where professional expertise is appropriate
• Assist in conducting investigations and audits related to fraud, abuse, and waste through research and analysis of complex health and business-related data
• Utilizing open-source and proprietary resources to plan and conduct audits as well as monitoring and tracking the associated case status
• Preparing referrals to law enforcement and other 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
• Collaborating with peer reviewers

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)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1,001-5,000 employees