68064379 - MEDICAL HEALTH CARE PROGRAM ANALYST

Requisition No: 882089 Agency: Agency for Health Care Administration Working Title: 68064379 - MEDICAL HEALTH CARE PROGRAM ANALYST Pay Plan: Career Service Position Number: 68064379 Salary: $1,833.39 Biweekly Posting Closing Date: 09/01/2026 Total Compensation Estimator Tool The Agency for Health Care Administration was statutorily created by Chapter 20, Florida Statutes as the chief health policy and planning entity for the state. We are primarily responsible for the state's estimated $38 billion Medicaid program that serves approximately 4.7 million Floridians, the licensure and regulation of the state's more than 50,500 health care facilities and empowering consumers through health care transparency initiatives. Bureau Of Medicaid Program Integrity To effectively serve our large recipient 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. Position Overview This is a career service position located in the Tampa 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. Benefits Of Working For The State Of Florida 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 For a more complete list of benefits, please visit Knowledge, Skills, And Abilities 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, 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. Minimum Qualifications Requirements Two years of professional or nonprofessional experience in a regulatory or health service setting. An associate’s degree from an accredited college or university can substitute on a year for year basis in a related field such as health law, health science, health services administration, business administration, public administration, sociology, criminology, criminal justice, or a substantially similar discipline. 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, data, or information analysis. Licensure, Certification, Or Registration Requirements N/A

CONTACT:

HELEN GUNN View phone number on click.appcast.io

BACKGROUND SCREENING

It is the policy of the Florida Agency for Health Care Administration that any applicant being considered for employment must successfully complete a State and National criminal history check as a condition of employment before beginning employment, and, if applicable, also be screened in accordance with the requirements of Chapter 435, F.S., and Chapter 408, F.S. No applicant may begin employment until the background screening results are received, reviewed for any disqualifying offenses, and approved by the Agency. Background screening shall include, but not be limited to, fingerprinting for State and Federal criminal records checks through the Florida Department of Law Enforcement (FDLE) and Federal Bureau of Investigation (FBI) and may include local criminal history checks through local law enforcement agencies. Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center View phone number on click.appcast.io). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation. The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.

VETERANS’ PREFERENCE.

Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans’ Preference will receive preference in employment for Career Service vacancies and are encouraged to apply. Certain service members may be eligible to receive waivers for postsecondary educational requirements. Candidates claiming Veterans’ Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code. Veterans’ Preference documentation requirements are available by clicking here . All documentation is due by the close of the vacancy announcement. #J-18808-Ljbffr State of Florida