68900188 - OPS GOVERNMENT ANALYST II

Ops Government Analyst II

This is a full-time OPS position, with regularly scheduled hours of Monday-Friday 8 : 00 a.m. to 5 p.m. This position will be hired at $25.00 hourly 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 Agency for Health Care Administration is Florida's chief health policy and planning entity. The Agency is responsible for administering the Florida Medicaid program, the licensure and regulation of nearly 50,000 health care facilities, and empowering consumers through health care transparency initiatives.

Position Overview : This OPS Government Analyst II position will support the Bureau of Medicaid Program Integrity (MPI) efforts. The Bureau of Medicaid Program Integrity (MPI) does this specifically through audits and investigations of healthcare providers, including managed care plans. MPI is organized by the functions that fall within the Bureau's responsibility : Fraud and Abuse Detection, Prevention, Overpayment Recovery, and Managed Care oversight. A candidate selected for the OPS Government Analyst II 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.

Key responsibilities include conducting data and programmatic analyses, performing desk audits, coordinating with internal staff and peer reviewers, and collaborating with attorneys to support and defend work products throughout the judicial process. Also, the candidate will support the work of other analysts by serving as a subject matter expert if necessary. MPI's Practitioner Care Unit is seeking a candidate with Behavioral Health training and experience. The candidate will use professional expertise and knowledge as well as professional standards to conduct efficient, effective research, analysis, reviews, investigations, and audits, to determine violations of Medicaid policies, establish overpayments, and make referrals.

Consult with staff to determine areas of concern and potential audit strategies to evaluate providers effectively and efficiently. Participate in on-site investigations where professional expertise is appropriate. Working in this position requires a broad array of knowledge and experience related to compliance assessment, legal analysis, and the investigative process as well as a desire to innovate. The selected candidate will assist in conducting investigations and audits related to fraud, abuse, and waste through research and analysis of complex health and business-related data.

Included in the functions of this position are activities such as : Utilizing open-source and proprietary resources to plan and conduct audits as well as monitoring and tracking the associated case status. Preparing referrals to law enforcement and other entities. Identifying, analyzing, and interpreting trends or patterns in data sets, as well as other investigative and research tools. Collaborating with team members on projects and assignments. Collaborating with peer reviewers.

Benefits of Working for the State of Florida : Working for the State of Florida is more than a paycheck. The State's total compensation package for Other Personal Services (OPS) employees features a highly competitive set of employee benefits including : No state income tax for residents of Florida; State Group Insurance coverage options (must meet eligibility requirements), including health, life, dental, vision, and other supplemental insurance options; Savings & Spending Accounts; 401 (a) FICA Alternative Plan administered through VALIC (tax deferred Retirement Savings Plan); Participation in the Florida Deferred Compensation Plan (457b)

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 features including, Word, Excel, Outlook, and Internet Explorer. Ability to travel with or without accommodation. Knowledge of the Florida Medicaid Program. Knowledge of research or investigative principles, practices, and techniques. Possess investigative skills, research skills, written and oral communication skills, and organizational skills.

MINIMUM QUALIFICATIONS REQUIREMENTS One year of professional experience in health care within a service delivery, administrative, regulatory, or oversight setting. Preference will be given to candidates with a bachelor's degree or higher from an accredited college or university, particularly in a related field such as : healthcare administration, psychology, social work, counseling, nursing or a substantially similar discipline. Preference will be given to candidates with Behavioral Health experience or training. Including professional licensure such as LMHC, LCSW, LMFT or Behavioral Analysis Certification. 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; or Certified Compliance and Ethics Professional.

CONTACT : HELEN GUNN 850-412-4626

Background screening is required as a condition of employment before beginning employment. 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.