68900289 - OPS MEDICAL/HEALTH CARE PROGRAM ANALYST

Requisition No: 851869 

Agency: Agency for Health Care Administration

Working Title: 68900289 - OPS MEDICAL/HEALTH CARE PROGRAM ANALYST

 Pay Plan: Temp

Position Number: 68900289 

Salary:  $20.00 Hourly 

Posting Closing Date: 05/08/2025 

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Position Overview:

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

The OPS Medical Health Care Program Analyst position is anticipated to be filled at $20.00 /hour 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.

 

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 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. 

Resolving the complexity and scope of fraudulent and abusive behavior in the Florida Medicaid program, these units work within the current framework while constantly seeking new and innovative strategies, 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 experienced backgrounds.

 

A candidate selected for a position with an investigative unit (Detection and Prevention) will be 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. 

A candidate selected for a 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.

 

The selected candidate will also be responsible for working collaboratively with other MPI operational units and participating in special projects.

The candidate will 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.

Successful candidates must demonstrate the working knowledge and experience specifically related to fraud prevention programs, compliance assessment, and report writing in the investigative and audit process.

 

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 e