Medicaid Fraud & Compliance Analyst

My Florida Families; Miami, Northern (FL, KY); Hybrid; USD 23,000 - 32,000; Full time

Job summary

Agency for Health Care Administration in Florida seeks an OPS Medical Health Care Program Analyst to support fraud and abuse prevention within the Medicaid Program Integrity unit. The role involves investigations, audits, and on-site visits to ensure policy compliance and identify overpayments.

The position covers 1-15% travel, requires background screening, and offers the standard OPS benefits; it’s a full-time hourly role at $20.00/hour with nondiscretionary pay.

Qualifications

• Two years of investigative, enforcement, health care, or regulatory experience.
• Bachelor's degree or higher in a related field preferred.
• Program integrity or fraud investigation certifications are a plus.

Responsibilities

• Conduct investigations and audits of Medicaid providers.
• Visit providers and identify overpayments.
• Prepare investigative summaries and referrals to law enforcement or other entities.
• Collaborate with MPI units and regulatory agencies on projects.
• Utilize data tools to monitor and track case status.

Skills

Problem solving

Decision making

Investigations

Research

Independent work

Communication

Regulatory knowledge

Microsoft Excel

Microsoft Word

Microsoft Outlook

Microsoft Edge

Education

Bachelor's degree or higher in a related field

Tools

Microsoft Word

Microsoft Excel

Outlook

Edge

Job description

Agency for Health Care Administration in Florida seeks an OPS Medical Health Care Program Analyst to support fraud and abuse prevention within the Medicaid Program Integrity unit. The role involves investigations, audits, and on-site visits to ensure policy compliance and identify overpayments.

The position covers 1-15% travel, requires background screening, and offers the standard OPS benefits; it’s a full-time hourly role at $20.00/hour with nondiscretionary pay.