MEDICAL HEALTH CARE PROGRAM ANALYST

Requisition No: 865623

Agency: Agency for Health Care Administration

Working Title: 68064693 - MEDICAL HEALTH CARE PROGRAM ANALYST

Pay Plan: Career Service

Position Number: 68064693

Salary: $1,833.39 Biweekly

Posting Closing Date: 12/03/2025

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

This Medical Health Care Program Analyst position is anticipated to be filled at a rate of $1,833.39 biweekly 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.

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.

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: Operations, Data Detection, Investigations, 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 MHCPA position is responsible for conducting investigations and developing fraud, waste, and abuse referrals of providers participating in the Florida Medicaid 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 will be responsible for identifying, analyzing, and interpreting trends or patterns in complex data sets, as well as other investigative and research tools to generate referrals to appropriate law enforcement, investigative, or regulatory agencies, as well as engage in other prevention activities, including pre-payment reviews, paid claims reversals, site visits, identifying and processing sanctions of providers, including fines, suspensions and terminations from participation in the Medicaid program, and imposing payment restrictions.

The selected candidate may be responsible for conducting 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.

MPI is 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 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 investigations/audits related to fraud, abuse, and waste through research and analysis of complex health and business-related data.

Included in the functions of this MHCPA position are activities such as:

• Utilizing open-source and proprietary resources to conduct the investigations and related administrative actions, as well as monitoring and tracking the associated case status.

• Issuing audit reports or preparing referrals to law enforcement or other entities involving Medicaid providers.

• 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.

• Conducting payment restriction reviews in accordance with state and federal rules, laws, and statutes.

Benefits of Working for the State of Florida:

Working for the State of Florida is more than a paycheck. We offer an excellent array of benefits, including:

• Health insurance (i.e., individual and family coverage) to eligible employees

• Life insurance; $25,000 policy is free plus option to purchase additional life insurance

• Dental, vision and supplemental insurance

• State of Florida retirement options, including employer contributions

• Ability to earn up to 104 hours of paid annual leave as a new employee with the State of Florida

• Ability to earn up to 104 hours of sick leave annually

• Nine paid holidays and 1 personal holiday each year

• Opportunities for career advancement

• Tuition waivers (accepted by major Florida Colleges/universities)

• Student loan forgiveness opportunities (eligibility required)

• Training opportunities

• Flexible Spending Accounts

• Shared Savings Program for select medical services

• Lower copays for prescription drugs

• Health and Wellness discounts

For a more complete list of benefits, please visit https://www.mybenefits.myflorida.com/

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 Word, Excel, Outlook, PowerPoint, and SharePoint.

• Ability to travel with or without accommodation.

• Ability of strong research skills, written and oral communication skills, and organizational skills.

• Knowledge of the Florida Medicaid Program.

• Knowledge of research or investigative principles, practices, and techniques.

MINIMUM QUALIFICATIONS REQUIREMENTS

• Two years of experience in compliance enforcement, investigative, oversight, regulatory or health care services setting.

• An associate’s degree from an accredited college or university can substitute on a year for year basis in a related field such as health law, health science, health services administration, business administration, public administration, sociology, criminology, or a substantially similar discipline.

• 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; Certified Compliance and Ethics Professional, or other relevant certification, such as: Project Management Professional.

LICENSURE, CERTIFICATION, OR REGISTRATION REQUIREMENTS

N/A

CONTACT: HELEN GUNN 850-412-4626

BACKGROUND SCREENING

It is the policy of the Florida Agency for Health Care Administration that any applicant being considered for employment must successfully complete a State and National criminal history check as a condition of employment before beginning employment, and, if applicable, also be screened in accordance with the requirements of Chapter 435, F.S., and Chapter 408, F.S. No applicant may begin employment until the background screening results are received, reviewed for any disqualifying offenses, and approved by the Agency. Background screening shall include, but not be limited to, fingerprinting for State and Federal criminal records checks through the Florida Department of Law Enforcement (FDLE) and Federal Bureau of Investigation (FBI) and may include local criminal history checks through local law enforcement agencies.

The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.

Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.

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.

VETERANS’ PREFERENCE. Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans’ Preference will receive preference in employment for Career Service vacancies and are encouraged to apply. Certain service members may be eligible to receive waivers for postsecondary educational requirements. Candidates claiming Veterans’ Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code. Veterans’ Preference documentation requirements are available by clicking here. All documentation is due by the close of the vacancy announcement.