68900289 - OPS Medical/Health Care Program Analyst

Business and Financial Operations; Miami (FL); On-site; USD 60,000 - 90,000; Full time

Job summary

Agency for Health Care Administration seeks an analyst for the Bureau of Medicaid Program Integrity in Florida. The role focuses on investigations and audits of Medicaid providers to prevent fraud, waste, and overpayments.

You will analyze complex health and business data, prepare audit reports, and coordinate with regulatory agencies to ensure compliance and accountability. On-site duties include visits and data analysis, with referrals to law enforcement when appropriate.

Qualifications

• Knowledge of fraud prevention programs and compliance assessment.
• Experience with investigative and audit processes.
• Ability to analyze complex health and business-related data.
• Familiarity with Medicaid policies, state and federal law, and regulations.
• Strong written and verbal communication skills.
• Experience with data analysis tools and case tracking systems.

Responsibilities

• Conduct investigations and audits of managed care plans and providers.
• Analyze complex health and business data.
• Issue audit reports detailing findings and recommendations.
• Collaborate with regulatory agencies to identify fraud, waste and overpayments.
• Coordinate on-site visits and data analysis using proprietary resources.
• Coordinate with law enforcement referrals as needed.

Skills

Fraud prevention knowledge

Investigations

Data analysis

Regulatory knowledge

Communication skills

Case tracking systems

Tools

Data analysis tools

Case tracking systems

Job description

This is a full-time temporary OPS position with the Agency for Health Care Administration's Bureau of Medicaid Program Integrity, supporting fraud and abuse prevention efforts within Florida's Medicaid program. The analyst will conduct investigations and audits of managed care plans and providers, analyze complex health and business data, issue audit reports, and collaborate with regulatory agencies to identify fraud, waste, and overpayments. The role involves on-site visits, data analysis using proprietary resources, and coordination with law enforcement referrals.

Key qualifications:

• Knowledge of fraud prevention programs and compliance assessment
• Experience with investigative and audit processes
• Ability to analyze complex health and business-related data
• Familiarity with Medicaid policies, state and federal law, and regulations
• Strong written and verbal communication skills
• Experience with data analysis tools and case tracking systems