Medical Health Care Program Analyst

Overview

Requisition No:865623

Agency:
Agency for Health Care Administration

Working Title:

- MEDICAL HEALTH CARE PROGRAM ANALYST

Pay Plan:
Career Service

Position Number:

Salary: $1,833.39 Biweekly

Posting Closing Date: 01/27/2026

This is a full-time career service position, with regularly scheduled hours of Monday-Friday 8:00 a.m. to 5:00 p.m.

This Medical Health Care Program Analyst position is anticipated to be filled at a rate of $1,833.39 biweekly and is non-negotiable.

This position may involve travel-related activities from 1-15%.

Successful completion of a criminal background investigation is a condition of employment.

A good attendance record is essential for any individual in this position as the work involved occurs daily and is time sensitive.

The individual in this position is expected to report to work daily and on time.

This Medical Health Care Program Analyst position will support the fraud and abuse prevention efforts within the Bureau of Medicaid Program Integrity (MPI).

MPI is organized by the functions that fall within the Bureau’s responsibility:
Operations, Data Detection, Investigations, Overpayment Recovery, and Managed Care oversight.

MPI operates with dynamic and fast-paced units that work closely with one another to serve the overall bureau mission.

To address the complexity and scope of fraudulent and abusive behavior in the Florida Medicaid program, these units are responsible for developing novel methods and technologies to fight fraud, abuse, and waste.

To do this, these highly collaborative and innovative units rely on teams with diverse educational and experience backgrounds.

The candidate selected for this MHCPA position is responsible for conducting investigations and developing fraud, waste, and abuse referrals of providers participating in the Florida Medicaid program to ensure they are meeting program integrity requirements set forth in state and federal law, as well as the provisions of contract and Medicaid policy.

This selected candidate will be responsible for identifying, analyzing, and interpreting trends or patterns in complex data sets, as well as other investigative and research tools to generate referrals to appropriate law enforcement, investigative, or regulatory agencies, as well as engage in other prevention activities, including pre-payment reviews, paid claims reversals, site visits, identifying and processing sanctions of providers, including fines, suspensions and terminations from participation in the Medicaid program, and imposing payment restrictions.

The selected candidate may be responsible for conducting audits, writing summary reports, and making referrals to other entities involving Medicaid providers or issuing audit reports in accordance with state and federal rules, laws, and statutes.

The selected candidate will also be responsible for working collaboratively with other MPI operational units and participating in special projects.

MPI is seeking candidates with a broad array of knowledge and experience specifically related to fraud prevention programs, compliance assessment, and investigative and audit processes.

This position requires a broad array of knowledge and experience specifically related to fraud prevention programs, compliance assessment, legal analysis, and the investigative process as well as a desire to innovate.

The selected candidate will assist in conducting investigations/audits related to fraud, abuse, and waste through research and analysis of complex health and business-related data.

Included in the functions of this MHCPA position are activities such as:

• Utilizing open-source and proprietary resources to conduct the 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.
• Collaborating with team members on projects and assignments.
• Conducting payment restriction reviews in accordance with state and federal rules, laws, and statutes.

Benefits of…