Medicaid Policy & Complaint Analyst

Florida; North Fort Myers (FL); On-site; USD 44,000 - 58,000; Full time

Benefits offered by this job

Health insurance

Life insurance

Dental and vision insurance

State retirement options

Paid annual leave

Job summary

Agency for Health Care Administration in Florida is seeking a MEDICAL/HEALTH CARE PROGRAM ANALYST to improve health care delivery through the Florida Medicaid Program. The role requires creativity, flexibility, and teamwork in a fast-paced environment.

You will serve within the Bureau of Medicaid Recipient Services, handling complaints, researching policy questions, and coordinating with recipients, providers, and plan management staff. Non-remote employment is specified.

Qualifications

• Two years of experience in developing, evaluating and/or using data reports; for planning, workload analysis or monitoring purposes including two years of Microsoft Excel or similar software experience.
• Three years of experience explaining policies and procedures to customers with a limited understanding of the subject matter or researching and resolving customer issues and complaints.

Responsibilities

• The incumbent in this position serves as a team lead for the Complaint Operations Center and provides policy and procedural guidance to unit staff.
• The incumbent in this position shall maintain up-to-date knowledge concerning the Florida Medicaid program, including pertinent Federal laws and regulations, state statutes and rules, the Florida Medicaid State Plan and its amendment processes, Medicaid Managed Care Waivers and Medicaid program manuals.
• The incumbent in this position shall remain informed about the operations of the Medicaid fiscal agent, including Medicaid claims processing, billing procedures, reimbursement methodologies and provider enrollment.
• The incumbent in this position shall remain informed about Medicare and other federal and state health care related programs, including other state and national Medicaid-related research and demonstration projects, health care program innovations for special populations, and alternative financing and service delivery systems models.
• The incumbent shall maintain knowledge about the Medicaid State Plan, waivers, regulations, and processes.
• The incumbent in this position shall maintain up-to-date knowledge of current Statewide Medicaid Managed Care (SMMC) contract provisions and amendments, SMMC talking points and guidance statements, SMMC plan subcontractors and TPAs, and SMMC all-plan communications distributed by the Agency.
• The incumbent shall coordinate with Medicaid recipients, providers, policy staff, plan management staff, and SMMC plans as needed to research and resolve assigned Medicaid managed care issues and document their activities in the complaint module, per current protocols.
• The incumbent shall alert their immediate supervisor if/when plan responses are not received by due date, the plan’s actions appear to be non-compliant with specific contract provisions, and/or the information provided by the plan in response to any issue appears to be insufficient or inaccurate.
• The incumbent in this position shall receive, research, and respond to Legislative Assignments, CorrFlow, and other special assignments regarding questions, and priority issues on behalf of Medicaid recipients and providers.
• Contact constituent to obtain information. Research, resolve, and respond to issues, making appropriate referrals as needed.
• Ensure updates are provided to the legislative office and/or Agency headquarters on actions taken to resolve the issue.
• Maintain ongoing communication with constituents throughout the process.
• The incumbent shall provide Medicaid policy expertise to other unit staff regarding routine legislative assignments.
• The Incumbent In This Position Shall Support And Assist With Healthcare Facility Closures And/or Medicaid Terminations, As Needed, Including The Following Tasks
• Assists with delivery of notices to facilities and residents, establishing telephone contact with family members/responsible parties and contact guardian where appropriate.
• Distributes "Family Information Kit” and works with identified Medicaid residents or appropriate legal representatives to secure alternative placement and provide appropriate counseling.
• Coordinates transportation to new facility verifying resident ID and transfer location.
• Provides on-site presence throughout the closure/termination process at the request of HQA.
• Maintains ongoing communication between HQA and Medicaid Field Office staff throughout closure event.
• The incumbent shall represent the Agency on government and community partnerships, community outreach events, Medicaid overview presentations, transportation boards, community alliances, interagency agreement teams, local planning groups, HIV planning councils and social services agency forums as assigned.
• The incumbent shall review complaints in a pending review status and conduct a random sampling of issues assigned to Complaint Operations Unit staff, as assigned, according to current protocols.
• Reports any deficiencies to the unit supervisor for staff correction and coaching.
• The incumbent acts as delegate for the Program Operations Administrator, as needed.

Job description

Agency for Health Care Administration in Florida is seeking a MEDICAL/HEALTH CARE PROGRAM ANALYST to improve health care delivery through the Florida Medicaid Program. The role requires creativity, flexibility, and teamwork in a fast-paced environment.

You will serve within the Bureau of Medicaid Recipient Services, handling complaints, researching policy questions, and coordinating with recipients, providers, and plan management staff. Non-remote employment is specified.