68900237 - OPS MEDICAL/HEALTH CARE PROGRAM ANALYST

My Florida Families; Tallahassee, Northern (FL, KY); Hybrid; USD 28,000 - 33,000; Full time

Job summary

Agency for Health Care Administration seeks an OPS Medical/Health Care Program Analyst to conduct investigations and generate referrals within Medicaid program integrity. The role emphasizes data-driven analysis, pre-payment reviews, audits, and collaboration across MPI teams.

The incumbent will work Mon-Fri 8:00 a.m. – 5:00 p.m. in a full-time OPS position, with an hourly wage of $20.00, non-negotiable, and requires successful background screening.

Qualifications

• Two years of professional or nonprofessional experience in a regulatory or health service setting.
• Associate degree substitution allowed year-for-year for related fields.
• Preference for program integrity related certification (e.g., CFE, AHFI, CFEI) or related PM certifications.
• Experience in business or information analysis is a plus.

Responsibilities

• Conduct investigations and develop fraud, waste, and abuse referrals for Medicaid providers.
• Identify, analyze, and interpret trends in complex data sets to inform referrals to law enforcement or regulatory bodies.
• Perform pre-payment reviews, paid claims reversals, and site visits.
• Prepare audit reports and assist with referrals to other entities.
• Collaborate with MPI units and participate in special projects.

Skills

Investigation

Data analysis

Written and verbal communication

Independence

Education

Associate degree in health/administration

Preferred: program integrity certification

Tools

FACTS

MS Word

MS Excel

PowerPoint

SharePoint

Job description

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68900237 - OPS MEDICAL/HEALTH CARE PROGRAM ANALYST

Date: Sep 29, 2026

The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website .

Requisition No:884636

Agency: Agency for Health Care Administration

Working Title: 68900237 - OPS MEDICAL/HEALTH CARE PROGRAM ANALYST

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

This OPS Medical Health Care Program Analyst position is anticipated to be filled at $20.00 hourly and is non-negotiable.

Successful completion of a criminal background investigation is a condition of employment.

This OPS 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 OPS 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, 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 OPS MHCPA position are activities such as:

• Utilizing open-source and proprietary resources to conduct 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.
• Assigning and deactivating user accounts and access privileges in FACTS, preparing and submitting operational, managerial, and ad-hoc reports extracted from FACTS data, and informing users of changes, trends, developments, and updates through written and verbal forms of communication and training.
• 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.

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)

OPS employment is a temporary employer/employee relationship used for accomplishing short term or intermittent tasks.

OPS employees are at-will employees and are subject to actions such as pay changes, changes to work assignment, and terminations at the pleasure of the agency head or designee.

OPS employees do not serve probationary periods or become permanent in their positions because they serve at the pleasure of the agency head.

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 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.
• Preference will be given to candidates with professional experience in business or information analysis.

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.

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.