Requisition No: 829796 

Agency: Agency for Health Care Administration

Working Title: 68064720 - GOVERNMENT OPERATIONS CONSULTANT III

 Pay Plan: Career Service

Position Number: 68064720 

Salary: $1,851.56 - $2,407.03 Biweekly 

Posting Closing Date: 06/04/2024 

Total Compensation Estimator Tool

Agency Overview:

The Agency for Health Care Administration (AHCA) is Florida's chief health policy and planning entity.

The Agency is responsible for administering the Florida Medicaid program, the licensure and regulation of nearly 50,000 health care facilities, and empowering consumers through health care transparency initiatives.

Under the direction of the Agency Secretary, AHCA is focused on advancing Governor DeSantis’ vision for Florida’s health care system to be the most cost-effective, transparent, and high-quality health care system in the nation.

The Medicaid program provides low-income families and individuals with access to health care.

If you have a desire to use your talent and skills at an organization that provides critical services to millions of individuals and families across the state, AHCA invites you to apply to become an essential member of our team.

As one of Florida’s leading state agencies, AHCA’s diverse workforce community of more than 1,400 employees is proud of its efforts to serve the people of Florida.

Agency Objectives:

HIGH QUALITY

Emphasizing quality in all that we do to improve health outcomes, always putting the individual first.

TRANSPARENT

Supporting initiatives that promote transparency and empower consumers in making well informed healthcare decisions.

COST-EFFECTIVE

Leveraging Florida’s buying power in delivering high quality care at the lowest cost to taxpayers.

Position Overview:

This is an exciting opportunity to help shape the quality of health care in Florida.

We are seeking to hire Government Operations Consultant III who desires to work to enhance the delivery of health care services through the Florida Medicaid Program.

This position requires a candidate who is creative, flexible, innovative, and who will thrive in a fast-paced, team based work environment.

This position is located in the Bureau of Medicaid Program Finance (MPF).

MPF manages and projects Florida’s $34.5 billion Medicaid Services budget, oversees financial reporting of the Agency’s contracted Medicaid health plans, calculates both institutional and non-institutional Medicaid reimbursement rates, and disburses supplemental payments to Medicaid providers.

This position is responsible for plans and coordinates the tasks of monitoring, evaluating, and analyzing the efforts of the Medicaid program fiscal agent relative to mainframe computer processing of claims submitted by Medicaid providers.

Assists in the development of specifications and audit programs for data applications software for the transfer of extracted data to micro-computers for evaluation, error identification and corrective action statements to the fiscal agent and advises higher level management on problems/issues and resolutions.

Directs the monitoring of a review of each audit engagement or review assignment upon completion by audit staff and prepares reports to document findings and make recommendations for improvement to appropriate agency personnel regarding program policy weaknesses and claim processing deficiencies.

The report also contains recommendations to the Medicaid fiscal agent of procedural or computer systems changes relative to inappropriate adjudication and for payment recoupment.

Prepares quarterly reports identifying overpayments and recoupments due to audit findings.

Reviews responses to audit findings received from the Medicaid fiscal agent, making determinations to their sufficiency and updates outstanding audit findings tracking log.

Confers with agency and user organization management regarding findings, questions and recommendations developed as a result of each unit engagement/review assignment.

Develops and maintains microcomputer software applications for tracking audit findings resolution.

In consultation with the Office of Medicaid Fiscal Agent Operations, conducts routine or special independent audits of a moderately complex nature of all parties involved in the processing of Medicaid claims by the Medicaid fiscal agent and consults with staff to determine compliance with Medicaid program policy; including testing of computerized claims processing systems for accuracy, preparation of specifications and parameters of special reports for audit applications.

Implements policies and procedures of the agency and the audit and program analysis functions within the section.

Performs other functions considered necessary to continually upgrade the professional competency of the professional staff of the section.

Perform a quarterly review of the Forced/Denied Report (FLMC6500-R021) and Services Force Paid by Claims Examiners (FLMC 6500-R015) and report any system or adjudication errors to the supervisor.

Cooperates with and assists state and federal auditors in the conduct of their examinations.

Assists agency’s Report Card coordinator in reviewing documentation supporting sample items selected for the report card review.

Also, conducts in-house reviews as determined necessary by the coordinator.

Maintains up-to-date knowledge concerning the Florida Medicaid program, including pertinent statutes, Florida State Plan for Medicaid, Florida administrative rules and regulations, program manuals and operations of the Medicaid fiscal agent.

Reviews draft policy manuals, billing guidelines, and administrative rule changes, provides comments to appropriate unit.

Responsible to Regulatory Analyst Supervisor requests for evaluation of fiscal analysis associated with the Health Insurance Portability and Accountability Act (HIPAA).

Act as agency contract manager for assigned Medicaid contracts, which shall include but may not be limited to the

following functions: Maintain active agency contract manager certification; Adhere to established agency procurement policies and procedures; Participate in the competitive and non-competitive procurement and development of assigned contracts; Oversee the day-to-day administrative, programmatic, and financial operations of assigned contracts; Enforce performance of assigned contract terms and conditions; Perform contract monitoring of vendor performance at least annually; Maintain appropriate and up-to-date contract files; and Serve as liaison with assigned contract vendor(s). Ad hoc request as needed.

This position is not a remote or telework position; it will have to report to a Field Office or the Headquarters in Tallahassee.

Benefits of Working for the State of Florida:

Working for the State of Florida is more than a paycheck. The State’s total compensation package for employees features a highly competitive set of employee benefits including:

• State Group Insurance Coverage Options, including health, life, dental, vision, and other supplemental insurance options;

• Flexible Spending Accounts;

• State of Florida retirement options, including employer contributions;

• Generous annual and sick leave benefits;

• 9 paid holidays a year and 1 Personal Holiday each year;

• Career advancement opportunities;

• Tuition waiver for courses offered by Florida’s nationally ranked State University System;

• Training and professional development opportunities;

• And more!

For more information about the Bureau of Medicaid Program Finance, please visit our website at http://ahca.myflorida.com/Medicaid/index.shtml.

Join us at the Agency for Health Care Administration in fulfilling our mission to provide “Better Health Care for all Floridians.”

KNOWLEDGE, SKILLS, AND ABILITIES

Ability to communicate effectively, both verbally and orally.

Ability to formulate policies and procedures.

Ability to work independently.

Ability to collect and analyze financial data.

Ability to utilize problem solving techniques.

Knowledge of methods of data collection and analysis.

Knowledge of FMMIS operating System.

Knowledge of bank reconciliation.

Knowledge of accounting systems or financial databases

MINIMUM QUALIFICATIONS REQUIREMENTS

Three years of experience related to banking, accounting, auditing, mathematics, or financial analysis.

Four years of experience using Microsoft Excel, Word, and Outlook.

One year of experience working with accounting systems or financial databases.

Bachelor’s degree from an accredited college or university with a degree in a business-related field such as accounting, finance is highly preferred. Experience can also be substituted on a year-for-year basis.

Preference will be given to applicants with Medicaid experience.

Preference will be given to applicants with FLMMIS experience.

Preference will be given to applicants with contract management experience.

LICENSURE, CERTIFICATION, OR REGISTRATION REQUIREMENTS

N/A

CONTACT:JOHNNIE MAE PETERS 850-412-4101

BACKGROUND SCREENING

It is the policy of the Florida Agency for Health Care Administration that any applicant being considered for employment must successfully complete a State and National criminal history check as a condition of employment before beginning employment, and, if applicable, also be screened in accordance with the requirements of Chapter 435, F.S., and Chapter 408, F.S. No applicant may begin employment until the background screening results are received, reviewed for any disqualifying offenses, and approved by the Agency. Background screening shall include, but not be limited to, fingerprinting for State and Federal criminal records checks through the Florida Department of Law Enforcement (FDLE) and Federal Bureau of Investigation (FBI) and may include local criminal history checks through local law enforcement agencies.

The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.

Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.

The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.

VETERANS’ PREFERENCE. Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans’ Preference will receive preference in employment for Career Service vacancies and are encouraged to apply. Certain service members may be eligible to receive waivers for postsecondary educational requirements. Candidates claiming Veterans’ Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code. Veterans’ Preference documentation requirements are available by clicking here. All documentation is due by the close of the vacancy announcement.