68063482 - INSPECTOR SPECIALIST

Florida; Miami (FL); On-site; USD 42,000 - 56,000; Full time

Benefits offered by this job

Health insurance

Life insurance

Dental and vision coverage

Retirement options

Job summary

The Agency for Health Care Administration seeks an Inspector Specialist to conduct investigations into fraud, abuse, and waste within the Florida Medicaid program. You will perform on-site visits, prepare investigative reports, and collaborate with multiple units to enforce compliance with state and federal rules.

Strong analytical and communication skills are required, along with the ability to handle sensitive information and work in a fast-paced environment.

Qualifications

• Two years of investigative, enforcement, or health care experience in a regulatory/oversight setting.
• One year of planning, organizing, and coordinating work assignments.
• One year of professional use of Word, Excel, PowerPoint, Outlook.

Responsibilities

• Conduct investigations and site visits to determine Medicaid policy violations.
• Prepare investigative summaries and write referrals to law enforcement when needed.
• Identify overpayments and analyze billing data for potential fraud or abuse.
• Collaborate with MPI units and regulatory agencies on data-driven initiatives.
• Perform pre-audit preparations and follow unit protocols.

Skills

Investigative skills

Data analysis

Written communication

Report writing

Analytical thinking

Education

Associate's degree or equivalent in health law/health science/criminal justice

Program integrity certification (preferred)

Tools

MS Word

MS Excel

PowerPoint

Outlook

Job description

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The State Personnel System is an E-Verify employer. For more information.

Agency: Agency for Health Care Administration

Working Title: 68063482 - INSPECTOR SPECIALIST

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

This position has a Competitive Area Differential (CAD) and will be hired at $1,833.39 + $48.00 = $1,881.39 biweekly/non-negotiable.

This position may involve travel-related activities from 1-25%.

The Agency requires background and fingerprint screening as 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.

All applicants selected for interview will be required to perform a skills test that consist of proficient English reading and writing comprehension and an understanding about legal proceedings and investigations related to health care fraud and abuse.

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 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 health care providers, including managed care plans, suspected of engaging in fraudulent or abusive behavior, as well as through overpayment recoveries, administrative sanctions, and referrals of suspected fraud or other criminal violations to law enforcement for investigation.

MPI operates with dynamic and fast-paced units that work closely together to serve the overall mission of the Bureau.

A candidate selected for a position with an investigative unit will be responsible for conducting investigations, visiting providers, identifying overpayments, writing investigative summary reports, and making recommendations for referrals to other entities involving Medicaid providers in accordance with state and federal rules, laws, and statutes.

The selected candidate will be expected to prepare, lead, and conduct pre-audit preparations, prepayment reviews, and project initiatives following the unit’s approved protocols.

The candidate should have experience in conducting interviews as well as investigations or other similar professional experience such as compliance monitoring or auditing sufficient to demonstrate the capability of analysis of Medicaid providers (billing information as well as other investigative findings) to determine violations of Medicaid policies and laws.

The selected candidate will be required to collaborate with other MPI operational units and regulatory agencies as well as to participate in joint data driven field initiatives.

The incumbent is responsible for conducting on-site visits to determine violations of Medicaid policies and is responsible for ensuring consistency and support regarding specific Prevention and Program Oversight (Field Operations) protocols.

This position requires a broad array of knowledge and experience specifically related to fraud prevention programs, compliance assessment, legal analysis, and report writing in the investigative and audit process as well as a desire to innovate.

The selected candidate will assist in conducting investigations 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 conduct the investigations and related administrative actions, as well as monitoring and tracking the associated case status.
• Preparing referrals to law enforcement 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.
• Conducting payment restriction reviews in accordance with state and federal rules, laws, and statutes.

This position has been identified as mission essential.

The incumbent in this position may be required to work during the weekend or on holidays.

In addition, mission essential personnel will be required to work during disasters, to include but not limited to, work before, during and/or beyond normal work hours or days in the event of an emergency.

Emergency work may involve the incumbent to work in another county or staffing location to assist other State Agencies with emergency work.

Emergency duties may include, but are not limited to, responses to or threats involving any disaster or threat of disaster, man-made or natural.

Benefits of Working for the State of Florida

• 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);
• 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

• Knowledge of research or investigative principles, practices, and techniques of research and analysis.
• Knowledge of Microsoft Word, Excel, PowerPoint, Outlook, and Internet Explorer.
• Knowledge of the Florida Medicaid Program.
• Ability to execute projects and assignments timely and accurately within a fast-paced environment.
• Ability to collect and analyze data.
• Ability to plan, design and conduct research studies.
• Ability to work independently.
• Ability to solve problems and make decisions based on available information.
• Ability to understand and apply applicable rules, regulations, policies, and procedures relating to research and analysis.
• Ability to conduct investigations, coordinate investigative activities, and accurately document the results of an investigation.
• Ability to communicate effectively verbally and in writing.
• Ability to establish and maintain effective working relationships with others.
• Ability to travel with or without accommodation.
• Possess investigative skills, research skills, written and oral communication skills, and organizational skills.

MINIMUM QUALIFICATIONS REQUIREMENTS

• Two years of investigative, enforcement, health care, or professional experience in a position within a regulatory, or oversight setting.
• One year of professional experience in planning, organizing, and coordinating work assignments.
• One year of professional use of computer software programs such as Word, Excel, PowerPoint, and Outlook.
• 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, criminology, criminal justice, 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; or Certified Compliance and Ethics 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.

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 All documentation is due by the close of the vacancy announcement.

For assistance, call the People First Service Center at [phone] Monday - Friday, 8:00 a.m. to 6:00 p.m., Eastern time. Pursuant to Florida Law, 110.211 F. S., the State of Florida is an EEO employer.