The Department of Management Services at MyFlorida is hiring a Medical Health Care Program Analyst for the Bureau of Medicaid Program Integrity (MPI). In this role, you will support fraud and abuse prevention efforts by providing compliance oversight of Managed Care Plans (MCPs) and conducting investigations into potential fraud or abuse committed by MCPs or their provider networks. You will play a key part in safeguarding program integrity through audits, overpayment identification, and detailed reporting.
What You'll Do
- Provide compliance oversight of Managed Care Plans (MCPs) to ensure they meet program integrity requirements set forth in law, contract, and policy.
- Conduct investigations into possible fraud or abuse committed by MCPs or their provider networks.
- Perform audits, visit providers, identify overpayments, write investigative summary reports, and make recommendations for referrals to other entities.
- Issue audit reports or prepare referrals to law enforcement or other entities involving Medicaid providers.
- Collaborate with other MPI operational units and regulatory agencies and participate in joint data-driven field initiatives and special projects.
- Utilize open-source and proprietary resources to conduct investigations/audits and related administrative actions, and monitor and track associated case status.
- Conduct on-site visits to determine violations of Medicaid policies.
- Assist in conducting investigations/audits related to fraud, abuse, and waste through research and analysis of complex health and business-related data.
- Identify, analyze, and interpret trends or patterns in data sets, as well as use other investigative and research tools.
- Assign and deactivate user accounts and access privileges in FACTS, prepare and submit operational, managerial, and ad-hoc reports extracted from FACTS data, and inform users of changes, trends, developments, and updates.
- Collaborate with team members on projects and assignments.
- Conduct payment restriction reviews in accordance with state and federal rules, laws, and statutes.
What We're Looking For
- Successful completion of a criminal background investigation is a condition of employment.
- A good attendance record is essential as work is daily and time-sensitive.
Nice to Have
- Broad array of knowledge and experience specifically related to fraud prevention programs, compliance assessment, and investigative and audit processes.
- 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.
Team & Environment
The Bureau of Medicaid Program Integrity (MPI) is organized by functions: Fraud and Abuse Detection, Prevention, Overpayment Recovery, and Managed Care oversight. MPI units are highly collaborative and innovative and rely on teams with diverse educational and experience backgrounds. The bureau operates with dynamic and fast-paced units that work closely together.
Benefits & Compensation
- Compensation: $1,833.39 Biweekly
Work Mode
This position requires onsite work.