Medicaid Program Integrity Investigator

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

Job summary

Agency for Health Care Administration in Florida seeks a full-time OPS Medical/Health Care Program Analyst to support fraud prevention within the MPI. The role involves conducting investigations/audits, visiting providers, preparing reports, and collaborating with regulatory agencies. Travel up to 15% may be required.

Background checks are mandatory, and the position is non-negotiable at $20.00 per hour. The Medicaid program in Florida is large, with a multi-billion dollar budget and thousands

Qualifications

• Two years of investigative, enforcement, health care, or professional experience in a regulatory/oversight setting.
• Bachelor's degree or higher from an accredited college or university in health law, health science, criminology, criminal justice, or a related field are preferred.
• Certification in program integrity or fraud investigation is preferred.
• Willingness to travel 1-15% as needed.

Responsibilities

• Conduct investigations/audits into Medicaid fraud, abuse, and waste.
• Visit providers and document findings; write investigative summary reports.
• Make referrals to law enforcement or other entities and issue audit reports as required.
• Collaborate with MPI units and regulatory agencies on data-driven field initiatives.
• Utilize open-source and proprietary resources to support investigations and track case status.

Skills

Problem solving

Investigations

Fact finding

written and verbal communication

Independent work

Regulatory knowledge

Microsoft Office

Travel willingness

Education

Bachelor's degree in related field

Professional certification in program integrity / fraud investigation (preferred)

Tools

FACTS system

MS Excel

MS Word

Job description

Agency for Health Care Administration in Florida seeks a full-time OPS Medical/Health Care Program Analyst to support fraud prevention within the MPI. The role involves conducting investigations/audits, visiting providers, preparing reports, and collaborating with regulatory agencies. Travel up to 15% may be required.

Background checks are mandatory, and the position is non-negotiable at $20.00 per hour. The Medicaid program in Florida is large, with a multi-billion dollar budget and thousands