Program Manager

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

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