68063525 - MEDICAL/HEALTH CARE PROGRAM ANALYST

Medical/Health Care Program Analyst

This is an exciting opportunity to help shape the quality of health care in Florida. We are seeking to hire a Medical/Health Care Program Analyst who desires to work to enhance the delivery of health care services through the Florida Medicaid Program. This position requires a candidate who is creative, flexible, innovative, and who will thrive in a fast-paced, team-based work environment. This position is located in the Bureau of Medicaid Program Finance (MPF). MPF manages and projects Florida's $34.4 billion Medicaid Services budget, oversees financial reporting of the Agency's contracted Medicaid health plans, calculates both institutional and non-institutional Medicaid reimbursement rates, and disburses supplemental payments to Medicaid providers. This position is responsible for planning, developing, and implementing cost reimbursement analysis activities. A person in this position will be responsible for assisting in the planning, development and implementation of Medicaid reimbursement policies and procedures; assisting in the development and implementation of short and long range plans for the cost reimbursement analysis subsection; developing and implementing cost reimbursement informational and operational procedures and manuals; assisting in the planning, development and implementation of procedures to audit data submitted by applicants for license to operate nursing homes and determine if applicants are adequately financed to operate the facility; auditing provider cost reports and establishing provider reimbursement rates; and developing procedures to evaluate requests from providers for increases in reimbursement rates to determine if an increase should be granted.

The objectives of these activities are to develop and implement a Medicaid reimbursement program which ensures providers that rates established will be in compliance with Medicaid policies and reimbursement plans; to develop, seek funding of and implement provider reimbursement methodologies which assure the provider fair and reasonable compensation for services rendered while also assuring that optimal results are obtained from public funds; and to develop cost reimbursement methodologies which result in a positive approach to health care cost containment.

Analyze and review nursing home provider budgeted cost reports and make appropriate adjustments to establish an interim budgeted rate. Set facility rates in accordance with Medicaid reimbursement plans and policies and applicable federal and state rules and regulations. Establish the initial FRVS asset base for new or replacement nursing home facilities. Identify the need for and obtain additional information and cost data from providers in order to set a facility's initial rate. Prepare cost report computer input sheets for all provider preliminary desk audits. Forward the initial budgeted rate notices to the appropriate Medicaid offices and to the fiscal agent. Calculation of depreciation/indexing recapture amounts and notification of providers and appropriate bureaus within the Agency in order to collect any calculated recaptures. Set facility rates in accordance with Medicaid reimbursement plans and policies and applicable federal and state rules and regulations. Coordinate all the activities necessary for the semi-annual (or annual, if mandated) rate settings for all nursing home providers enrolled in the Medicaid program. Update facility rates as audit and licensure results are made available. Review and analyze requests from Medicaid providers for rate adjustments and determine if a rate increase should be authorized. Calculate and set rates for the settlement of Medicaid interim reimbursement rates when the initial cost report becomes available. Verify that all rate changes are made correctly by the fiscal agent, and retro-active payments or adjustments are made appropriately by the fiscal agent for all rates the analyst is responsible for. Determination and update of lease bonds and lease bonds alternative amounts for nursing facilities and review of lease bond alternative fund to determine adequacy of funding levels in comparison to overpayments to leased facilities. Assist in preparing special reports and analyses on provider costs and the fiscal effect of the primary features of the nursing home cost reimbursement plan including the payment mechanism, rates, grouping criteria, caps, cost projections, inflation allowances, cost allocation, rate revision frequency, geographic differentials, rate appeals, cost reports, allowable costs, depreciation, quality of care incentives, and profit allowances. Perform complex statistical and financial analyses of Medicaid provider costs in long-term care and acute care facilities in order to assess their impact on overall Medicaid costs and for use in future Medicaid cost reimbursement planning. Assist in the development and compilation of various special management or provider cost comparisons from cost report data. Provide technical assistance and consultation to departmental staff, provider association, and other organizations and interested persons regarding policies and procedures for provider rate setting; assist in the preparation of informational and educational material on Medicaid provider rate setting; and assist in the development and implementation of cost reimbursement rate setting training programs. Maintain up-to-date knowledge concerning the Florida Medicaid program, including pertinent statutes, Florida rules, regulations of the Department of Health and Human Services, provider manuals, and Medicaid billing procedures. Remain informed about Medicaid activities of the Agency for Health Care Administration and about operations of the fiscal agent contractor. Maintain detailed knowledge of Medicaid financial and statistical information at both state and national levels. Maintain detailed knowledge of Medicare and other health care program cost reimbursement principles and the Medicaid cost reimbursement and rate setting methods of other states. Remain informed about health care cost containment issues on the local, state, and national level. Maintain detailed knowledge of accepted accounting and auditing principles, procedures, and techniques. Assist in the development of long-range plans for policy and procedures development, implementation and monitoring of cost reimbursement rate setting and analysis activities. Assist in the development of plans and schedules for the review and analysis of the rate setting and analysis function, provider cost report monitoring, special projects, surveys and studies and provider and staff training. Assist in developing plans for short term cost reimbursement analysis activities including policy revision, analysis of cost report data, provider reimbursement issues, and other areas. Assist in the development of analysis goals, objectives, and priorities. Assist in the development of performance standards and criteria in order to measure the accomplishment of goals and objectives. Assist in planning, developing, and implementing policies and procedures for provider rate setting and rate analysis. Assist in developing rate setting manuals as appropriate for the application of cost reimbursement plans and principles of reimbursement. Assist in planning for and coordinating the implementation of rate setting policies and procedures with other staff in the Bureau of Medicaid Program Finance, the Bureau of Medicaid Contract Management, the fiscal agent contractor, other departmental offices, districts, providers, and provider associations; assist in identifying and resolving any problems in the implementation of rate setting policy and procedure revisions. Review and analyze revisions to CMS Pub. 15-1, federal rules and regulations, and other related materials to determine their impact on rate setting policies and procedures. Review and analyze cost reports in order to determine common errors and provider difficulty in using cost report forms. Assist in the development of revisions to the cost report forms based on these analyses. Assist in the development and implementation of cost report forms that are designed for data entry; assist in the development and implementation of automated provider cost systems. Assist in the development and implementation of revised rate setting policies and procedures designed to increase the efficiency of the rate setting and analysis functions. Perform other duties and responsibilities as required. This position will report to the Headquarters location in Tallahassee. This position is not a remote or telework position.

Benefits of working for the State of Florida: Working for the State of Florida is more than a paycheck. We offer an excellent array of benefits, including:

• 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 .

Join us at the Agency for Health Care Administration in fulfilling our mission to provide "Better Health Care for all Floridians."

KNOWLEDGE, SKILLS, AND ABILITIES

Be proficient in the use of Excel, Outlook, and Microsoft Word. Be proficient in the use of a calculator and a computer terminal. Knowledge of accounting principles and procedures. Knowledge of the principles and techniques of effective written and verbal communications. Knowledge of basic mathematics and economics. Knowledge of financial forecasting techniques. Ability to adequately document work assignments completed. Ability to prepare audit reports. Ability to conduct research and investigations. Ability to review, analyze and evaluate financial and operational data. Ability to audit financial forecasted statements. Ability to compile statistical data. Ability to understand and apply laws, rules, regulations, policies, and procedures. Ability to process and respond to consumer complaints. Ability to verify the accuracy of numerical data. Ability to plan, organize and coordinate work assignments. Ability to communicate effectively verbally and in writing Ability to establish and maintain effective working relationships with others. Ability to prepare financial statements. Ability to utilize problem solving techniques.

MINIMUM QUALIFICATIONS REQUIREMENTS

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