Medicaid Program Integrity Analyst - Investigator

My Florida CFO; Miami (FL); On-site; USD 23,000 - 32,000; Full time

Job summary

The Agency for Health Care Administration seeks an OPS Medical Health Care Program Analyst to support the Bureau of Medicaid Program Integrity in preventing fraud, abuse and waste within Florida’s Medicaid program. The role conducts investigations, audits, and referrals, collaborates with MPI units and state agencies, and analyzes complex health and business data to enforce program integrity requirements.

The full-time position offers a fixed starting wage of $20.00 per hour, Monday–Friday 8:00

Qualifications

• Two years of investigative, enforcement, health care, or professional experience in a regulatory or oversight setting.
• Preference will be given to candidates with a bachelor's degree or higher in health law, health science, criminology, criminal justice, or related fields.
• Preference will be given to candidates with program integrity related professional certification (e.g., CFE, AHFI, CFII, CCEF).

Responsibilities

• Conduct investigations and audits of Medicaid providers and managed care plans.
• Identify overpayments, document findings, and prepare investigative summaries.
• Issue audit reports and make referrals to law enforcement or other entities as needed.
• Collaborate with MPI units and regulatory agencies on data-driven initiatives and projects.
• Review policies, laws, and regulations to ensure compliance with state and federal requirements.
• Monitor case status and communicate findings through written and verbal updates.

Job description

The Agency for Health Care Administration seeks an OPS Medical Health Care Program Analyst to support the Bureau of Medicaid Program Integrity in preventing fraud, abuse and waste within Florida’s Medicaid program. The role conducts investigations, audits, and referrals, collaborates with MPI units and state agencies, and analyzes complex health and business data to enforce program integrity requirements.

The full-time position offers a fixed starting wage of $20.00 per hour, Monday–Friday 8:00