68048395 - GOVERNMENT OPERATIONS CONSULTANT II
Date: Oct 9, 2024
The Agency for Health Care Administration (AHCA) is Florida's chief health policy and planning entity, 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.
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 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 Plan Management Operations (PMO), responsible for the primary oversight of Medicaid’s managed care programs.
This position is responsible for reviewing Medicaid managed care claim complaints and determining managed care compliance with the SMMC contract as it relates to claims processing.
Examples of work include:
- Analyzes programmatic reports of claims and provider reimbursement issues/complaints to determine managed care plan compliance with contract provisions.
- Coordinates and performs monitoring of Medicaid Managed Care Plan claim submission protocols and standard claim processing procedures.
- Follows established unit policies and procedures to ensure the compliance process is conducted consistently.
- Analyzes compliance issues and makes recommendations for compliance actions.
- Conducts program training to Medicaid managed care plans related to compliance with contract provisions.
- Maintains up-to-date knowledge concerning the Florida Medicaid Program.
- Participates in meetings and prepares and delivers speeches with the Agency and managed care organizations.
- Represents Medicaid on health care related committees, task forces, and special projects, as assigned.
This position may require travel and is not a remote or telework position; it will have to report to a Field Office or the 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.
- Knowledge of and ability to effectively utilize computer skills such as Microsoft Office 2016 (Word, Excel, Outlook).
- Ability to collect, evaluate and analyze data to develop alternatives, solve problems, and document workflow.
- Ability to organize data logically for presentation in reports and other written materials.
- Ability to conduct fact-finding research.
- Ability to utilize problem-solving techniques.
- Ability to work independently.
- Ability to understand and apply applicable rules, regulations, policies, and procedures.
- Ability to make timely decisions.
- Ability to verify accuracy of data.
- Ability to establish and maintain effective working relationships.
- Effective verbal and written communication skills.
- Ability to travel with or without accommodations.
MINIMUM QUALIFICATIONS REQUIREMENTS
- At least 2 years of medical claims billing experience or 2 years of medical claims processing experience.
- At least 2 years of experience researching and interpreting policies and procedures.
- At least 2 years of experience using computers and various software programs such as Outlook, Word, and Excel.
- At least 1 year of experience auditing or conducting monitoring of medical claims activities.
PREFERRED:
A Bachelor’s Degree or degree in a healthcare field from an accredited college or university is preferred. Professional or non-professional experience can substitute on a year-for-year basis for the preferred college education.
CONTACT: EDWARD WEISER 954-958-6513
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.
The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer. Candidates requiring a reasonable accommodation must notify the agency hiring authority.
The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with the 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.
Location: FT LAUDERDALE, FL, US, 33309
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