68022139 - GOVERNMENT OPERATIONS CONSULTANT II
Date: Oct 16, 2024
Requisition No: 833733
Agency: Agency for Health Care Administration
Working Title: 68022139 - GOVERNMENT OPERATIONS CONSULTANT II
The Agency for Health Care Administration (AHCA) is Florida's chief health policy and planning entity, responsible for administering the Florida Medicaid program and regulating nearly 50,000 health care facilities.
Position Overview:
This is an exciting opportunity to help shape the quality of health care in Florida. We are seeking to hire a Government Operations Consultant II who desires 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 Plan Management Operations (PMO), which is responsible for the primary oversight of Medicaid’s managed care programs, focusing on the Statewide Medicaid Managed Care (SMMC) program.
Responsibilities include:
- Analyzing programmatic reports of claims and provider reimbursement issues to determine managed care plan compliance with contract provisions.
- Coordinating and performing monitoring of Medicaid Managed Care Plan claim submission protocols and standard claim processing procedures.
- Conducting program training to Medicaid managed care plans related to compliance with contract provisions.
- Participating in meetings and preparing and delivering speeches with the Agency, managed care organizations, and other stakeholders.
This position may require travel and is not a remote or telework position; it will require reporting to a Field Office or Headquarters in Tallahassee.
KNOWLEDGE, SKILLS, AND ABILITIES
Knowledge of Medicaid eligibility, programs, policies, and benefit limitations.
Knowledge of medical claims processing and/or health insurance claims billing.
Knowledge of the methods of data collection and analysis.
Ability to collect, evaluate and analyze data to develop alternative recommendations.
MINIMUM QUALIFICATIONS REQUIREMENTS
- At least 2 years of medical claims billing or processing experience.
- At least 2 years of experience researching and interpreting policies and procedures.
- At least 1 year experience auditing or conducting monitoring of medical claims activities related to a healthcare program.
PREFERRED: A Bachelor’s Degree or degree in a healthcare field from an accredited college or university is preferred.
CONTACT: EDWARD WEISER 954-958-6513
BACKGROUND SCREENING: Successful completion of a State and National criminal history check is a condition of employment.
The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer.
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