Medicaid Fraud & Program Integrity Analyst (OPS)

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

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.