68064697 - MEDICAL/HEALTH CARE PROGRAM ANALYST

Requisition No: 849116 

Agency: Agency for Health Care Administration

Working Title: 68064697 - MEDICAL/HEALTH CARE PROGRAM ANALYST

 Pay Plan: Career Service

Position Number: 68064697 

Salary:  $1,794.92 Biweekly 

Posting Closing Date: 03/31/2025 

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This is a full-time career service position, with regularly scheduled hours of Monday-Friday 8:00 a.m. to 5 p.m. 

The Medical Health Care Program Analyst position is to be filled at a rate of $1,794.92 bi-weekly and is non-negotiable.

This position may involve travel related activities from 1-15%. 

Successful completion of a criminal background investigation is a condition of employment.

 

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 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.

 

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

The selected candidate will report to the Program Administrator, in the Bureau's Special Projects Unit. 

The position incorporates all of the functions that fall within the Bureaus' responsibility and works with the various units in MPI. 

The incumbent will be responsible for the coordination of program activities while supporting the operations of unit and bureau administrative activities and is expected to work both independently and in a group setting to complete work assignments related to bureau needs. 

This position will be privy to sensitive information and the incumbent is expected to maintain information in the strictest confidence. 

 

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. 

Addressing 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.

 

MPI's Detection and Prevention units are responsible for conducting investigations, writing summary reports, and making referrals to other entities involving Medicaid providers in accordance with state and federal rules, laws, and statutes. 

Overpayment Recovery and Managed Care units are responsible for conducting audits, writing summary reports, and issuing audit reports in accordance with state and federal rules, laws, and statues. 

 

The candidate will also be responsible for utilizing open-source and propri