MEDICAL HEALTH CARE PROGRAM ANALYST

Requisition No: 872407

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: 04/01/2026

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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 b/w 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.

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).

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.

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 position is responsible for identifying, investigating, and supporting the prevention of fraud, waste, and abuse with a primary focus on Durable Medical Equipment and Supplies (DME).

The position conducts complex claim analysis, performs targeted provider clinical and compliance reviews of records, evaluates compliance with Medicaid policy, state rules and laws, federal regulations, and maintains ongoing knowledge of emerging trends, policies, rules, laws, and federal regulations relevant to program integrity, and DME providers and services.

The selected candidate will also represent the Agency as a subject matter expert during administrative hearings.

The selected candidate may be responsible for conducting investigations/audits to identify aberrant billing patterns, improper utilization, and potential fraud or abuse within DME claims, 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, compliance site visits, and inspections.

The candidate will also be responsible for utilizing open-source and proprietary resources to conduct the audits, investigations and related administrative actions, as well as monitoring and tracking the associated case status.

This position requires a broad array of knowledge and experience specifically related to fraud prevention programs, compliance assessment, case management, 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 records.

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

• Conducting desk or onsite records reviews to determine documentation sufficiency, and compliance with Medicaid provisions, state laws and rules, and federal regulations.

• Developing findings and recommendations for overpayment recoveries, assessing sanctions, and making referrals to law enforcement partners.

• Interpreting claims in the context of clinical standards, policy requirements, and expected utilization patterns.

• Identifying deficiencies, patterns of noncompliance, and opportunities for provider education or corrective action.

• In collaboration with agency counsel, preparing testimony, exhibits, and expert statements that articulate clinical rationale, policy interpretation, and audit or investigative findings.

• Collaborating with team members on projects and assignments.

• Providing internal consultation and training on claim decisions, rules and guidelines, and issues related to program integrity of DME providers and services.

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, 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 professional or nonprofessional experience in a regulatory or health service 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, criminal justice, or a substantially similar discipline.

• Preference will be given to candidates with a coding certification, such as Certified Professional Coder, Certified Coding Specialist, Certified Professional Biller, Certified Professional Medical Auditor or other relevant equivalent.

• Preference will be given to candidates with respiratory therapy, occupational therapy, physical therapy, nursing, or durable medical equipment and supply setting experience.

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.

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.