68064376 - MEDICAL/HEALTH CARE PROGRAM ANALYST

Requisition No: 857390 

Agency: Agency for Health Care Administration

Working Title: 68064376 - MEDICAL/HEALTH CARE PROGRAM ANALYST

 Pay Plan: Career Service

Position Number: 68064376 

Salary:  $1,833.39 biweekly 

Posting Closing Date: 08/06/2025 

Total Compensation Estimator Tool

This is a full-time career service position, with regularly scheduled hours of Monday-Friday 8:00 a.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 biweekly/non-negotiable. This position may involve travel-related activities from 1-15%.  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. The individual in this position is expected to report to work daily and on time.

 

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 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, suspected of engaging in fraudulent or abusive behavior, as well as overpayment recoveries, administrative sanctions, and the referral of suspected fraud or other criminal violations for law enforcement investigation. 

 

This Medical Health Care Program Analyst position will support the fraud and abuse prevention efforts within the Bureau of Medicaid Program Integrity (MPI). 

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.  To address the complexity and scope of fraudulent and abusive behavior in the Florida Medicaid program, these units are responsible for developing novel methods and technologies to fight fraud, abuse, and waste. To do this, these highly collaborative and innovative units rely on teams with diverse educational and experience backgrounds.

 

The candidate selected for this position is responsible for providing compliance oversight of the Managed Care Plans (MCPs) participating in the Statewide Medicaid Managed Care program to ensure they are meeting program integrity requirements set forth in state and federal law, as well as the provisions of contract and Medicaid policy.  This selected candidate is also responsible for conducting investigations into possible fraud or abuse committed by the MCPs or their provider networks. 

 

The selected candidate may be responsible for conducting investigations/audits, 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 participating in special projects. The candidate will also be responsible for utilizing open-source and proprietary resources to conduct the audits and investigations and related administrative actions, as well as monitoring and tracking the associated case status. These units are seeking candidates with a broad array of knowledge and experience specifically related to fraud prevention programs, compliance assessment, and investigative and audit processes.  

 

This position will be responsible for communicating and consulting on the use, performance, enhancements and training of the Fraud and Abuse Case Tracking System (FACTS) by designing and monitoring oversight of system functionality and user accountability, conducting audits addressing the system with operational needs and services, and providing technical support,  guidance and assistance with contract management and vendors related to FACTS and assisting with support to effectively manage current contracts, ensuring compliance with established terms and conditions.  

 

This position requires a broad array of knowledge and experience specifically related to fraud prevention programs, compliance assessment, legal analysis, and the investigative process as well as a desire to innovate. The selected candidate will assist in conducting investig