State of Florida - Tallahassee, FL
posted 16 days ago
About the position
This is a full time OPS position, with regularly scheduled hours of Monday-Friday 8:00 a.m. to 5 p.m. This OPS Senior Human Services Program Specialist position is anticipated to be filled at a rate of $17.53 - $18.00 hourly, based on the selected candidate's qualifications and experience. This position may involve travel related activities from 1-15%. The Agency requires background and fingerprint screening as a condition of employment. The Florida Medicaid program is one the top five largest in the country and has an estimated $38 billion annual budget. Each month Florida Medicaid covers medical services for almost 4 million recipients. To most effectively serve this large patient population, one of the Agency goals is to ensure fewer budgeted dollars are lost to fraud, abuse, and waste. The Bureau of Medicaid Program Integrity (MPI) does this specifically through audits and investigations of healthcare providers suspected of engaging in fraudulent or abusive behavior, as well as overpayment recoveries, administrative sanctions, and the referral of suspected fraud or other criminal activities for law enforcement investigation. The Prevention Strategy Unit is a dynamic and fast-paced unit within MPI that works closely with other units to serve the overall bureau mission. To address the complexity and scope of fraudulent and abusive behavior in the Florida Medicaid program, the Prevention Strategy Unit is responsible for developing novel methods and technologies to fight fraud, abuse, and waste. To do this, the highly collaborative and innovative unit relies on a team with diverse educational and experience backgrounds.
Responsibilities
- Assisting with investigative activities.
- Utilizing open-source and proprietary resources to conduct the investigations and related administrative actions, as well as monitoring and tracking the associated case status.
- Assisting in preparing referrals to law enforcement entities.
- Identifying, analyzing, and interpreting trends or patterns in data sets, as well as other investigative and research tools.
- Collaborating with team members on projects and assignments.
- Conducting document reviews related to Program Integrity activities.
Requirements
- One year of investigative, enforcement, health care, or professional experience in a position within a regulatory, or oversight setting.
Nice-to-haves
- Bachelor's degree or higher from an accredited college or university, particularly in a related field such as: health law, health science, criminology, criminal justice, or a substantially similar discipline.
- Program integrity related professional certification, such as: Certified Fraud Examiner; Accredited Healthcare Fraud Investigator; Certified Financial Crimes Investigator; Certified Insurance Fraud Investigator; or Certified Compliance and Ethics Professional.
Benefits
- No state income tax for residents of Florida.
- State Group Insurance coverage options (must meet eligibility requirements), including health, life, dental, vision, and other supplemental insurance options.
- Savings & Spending Accounts.
- 401 (a) FICA Alternative Plan administered through VALIC (tax deferred Retirement Savings Plan).
- Participation in the Florida Deferred Compensation Plan (457b).
