Medicaid Program Integrity Analyst (OPS)

Florida; Tallahassee (FL); On-site; USD 23,000 - 32,000; Full time

Benefits offered by this job

Health insurance

No state income tax

Florida Deferred Compensation Plan

Job summary

Agency for Health Care Administration seeks an OPS Medical Health Care Program Analyst to conduct investigations and develop referrals to ensure Medicaid program integrity. You will analyze complex data, perform reviews, and collaborate across MPI units on special projects.

This full-time OPS role requires strong investigative skills, knowledge of health care regulations, and the ability to communicate findings clearly in writing.

Qualifications

• Two years of professional or nonprofessional experience in a regulatory or health service setting.
• Associate degree substitution on a year-for-year basis in related fields is acceptable.
• Preference will be given to candidates with program integrity certifications or PM/ethics related credentials.
• Preference will be given to candidates with experience in business or information analysis.

Responsibilities

• Conduct investigations and develop fraud, waste, and abuse referrals for Medicaid providers.
• Identify, analyze, and interpret trends in data sets using investigative tools.
• Write audit reports and prepare referrals to law enforcement or other entities.
• Collaborate with MPI units on projects and special assignments.
• Perform payment restriction reviews in line with state and federal rules.

Skills

Problem solving

Investigation

Written communication

MS Office

Data analysis

Medicaid knowledge

Research skills

Education

Associate degree or related field

Professional certification preference

Tools

FACTS system

SharePoint

Job description

Agency for Health Care Administration seeks an OPS Medical Health Care Program Analyst to conduct investigations and develop referrals to ensure Medicaid program integrity. You will analyze complex data, perform reviews, and collaborate across MPI units on special projects.

This full-time OPS role requires strong investigative skills, knowledge of health care regulations, and the ability to communicate findings clearly in writing.