Medicaid Program Integrity Analyst

State of Florida; Miami (FL); On-site; USD 28,000 - 32,000; Full time

Job summary

The State of Florida is seeking a Medical Health Care Program Analyst to support fraud prevention within the Medicaid program's Bureau of MPI. The role involves investigations, audits, and collaborations across regulatory bodies while ensuring compliance with state and federal requirements. Travel up to 15% may be involved.

The position requires a bachelor’s degree with strong investigative and analytical skills and offers a defined Monday–Friday work schedule in a full-time OPS role.

Qualifications

• 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 travel with or without accommodations.
• Knowledge of the Florida Medicaid Program.
• Knowledge of research or investigative principles, practices, and techniques.
• Possess investigative skills, research skills, written and oral communication skills, and organizational skills.

Responsibilities

• 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.

Skills

Investigation

Data analysis

Written communication

Oral communication

Regulatory knowledge

Education

Bachelor's degree

Tools

Microsoft Word

Excel

Outlook

Edge

Job description

The State of Florida is seeking a Medical Health Care Program Analyst to support fraud prevention within the Medicaid program's Bureau of MPI. The role involves investigations, audits, and collaborations across regulatory bodies while ensuring compliance with state and federal requirements. Travel up to 15% may be involved.

The position requires a bachelor’s degree with strong investigative and analytical skills and offers a defined Monday–Friday work schedule in a full-time OPS role.