People First Service Center
68048394 - GOVERNMENT OPERATIONS CONSULTANT II
People First Service Center, Fort Lauderdale, Florida, us, 33336
68048394 - GOVERNMENT OPERATIONS CONSULTANT II
The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website.
Requisition No: 864680
Agency: Agency for Health Care Administration
Working Title: 68048394 - GOVERNMENT OPERATIONS CONSULTANT II
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.
To use your talent and skills at an organization that provides critical services to millions 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 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 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.
Responsibilities include:
Reviewing Medicaid managed care claim complaints and determining managed care compliance with the SMMC contract as it relates to claims processing.
Analyzing programmatic reports of claims and provider reimbursement issues/complaints 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 through the review of claim complaints, claim forms, explanation of benefits, and authorizations to make a compliance determination.
Following established unit policies and procedures to ensure the compliance process is conducted consistently and reviewing findings to ensure they are documented appropriately.
Analyzing compliance issues and making recommendations for compliance actions when issues are identified in the managed care plan provider reimbursement and claims processes.
Conducting program training to Medicaid managed care plans related to compliance with contract provisions, provider reimbursement and claims processing requirements.
Maintaining up‑to‑date knowledge concerning the Florida Medicaid Program.
Participating in meetings, preparing and delivering speeches with the Agency, with managed care organizations and other stakeholders.
Representing Medicaid on health care related committees, task forces, and special projects, as assigned.
This position may require travel. This position is not a remote or teleworking position.
Benefits of Working for the State of Florida
Health insurance (individual and family coverage) to eligible employees.
Life insurance; $25,000 policy is free plus option to purchase additional life insurance.
Dental, vision and supplemental insurance.
State of Florida retirement options, including employer contributions.
Ability to earn up to 104 hours of paid annual leave as a new employee with the State of Florida.
Ability to earn up to 104 hours of sick leave annually.
Nine paid holidays and 1 personal holiday each year.
Opportunities for career advancement.
Tuition waivers (accepted by major Florida Colleges/universities).
Student loan forgiveness opportunities (eligibility required).
Shared Savings Program for select medical services.
Lower copays for prescription drugs.
Health and Wellness discounts.
For a more complete list of benefits, please visit
mybenefits.myflorida.com .
For more information about the Bureau of Plan Management Operations, please visit our website at
ahca.myflorida.com .
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
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).
Knowledge of the techniques used in compiling and analyzing data.
Ability to collect, evaluate and analyze data to develop alternative recommendations, solve problems, document workflow and other activities related to the improvement of operations.
Ability to organize data in a logical format for presentation in reports, documents 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 relating to operational activities.
Ability to make decisions in a timely manner.
Ability to verify accuracy of data.
Ability to establish and maintain effective working relationships with all levels of staff.
Possesses effective verbal and written communication skills.
Ability to travel with or without accommodation.
MINIMUM QUALIFICATIONS REQUIREMENTS
Two (2) years of experience in medical claims billing or medical claims processing with understanding of the Explanation of Payment and Explanation of Benefit Statements for health insurance companies/government healthcare related programs.
Two (2) years of experience researching and interpreting policies and procedures.
Two (2) years of experience using Microsoft Office (Outlook, Word, Excel, etc.) and various software programs.
One (1) year experience auditing or conducting monitoring of medical claims activities related to a healthcare program.
LICENSURE, CERTIFICATION, OR REGISTRATION REQUIREMENTS N/A
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 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 should 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.
Location FT LAUDERDALE, FL, US, 33309
Nearest Major Market: Fort Lauderdale
Nearest Secondary Market: Miami
For assistance, call the People First Service Center at 877-562-7287 Monday - Friday, 8:00 a.m. to 6:00 p.m., Eastern time.
#J-18808-Ljbffr
Requisition No: 864680
Agency: Agency for Health Care Administration
Working Title: 68048394 - GOVERNMENT OPERATIONS CONSULTANT II
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.
To use your talent and skills at an organization that provides critical services to millions 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 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 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.
Responsibilities include:
Reviewing Medicaid managed care claim complaints and determining managed care compliance with the SMMC contract as it relates to claims processing.
Analyzing programmatic reports of claims and provider reimbursement issues/complaints 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 through the review of claim complaints, claim forms, explanation of benefits, and authorizations to make a compliance determination.
Following established unit policies and procedures to ensure the compliance process is conducted consistently and reviewing findings to ensure they are documented appropriately.
Analyzing compliance issues and making recommendations for compliance actions when issues are identified in the managed care plan provider reimbursement and claims processes.
Conducting program training to Medicaid managed care plans related to compliance with contract provisions, provider reimbursement and claims processing requirements.
Maintaining up‑to‑date knowledge concerning the Florida Medicaid Program.
Participating in meetings, preparing and delivering speeches with the Agency, with managed care organizations and other stakeholders.
Representing Medicaid on health care related committees, task forces, and special projects, as assigned.
This position may require travel. This position is not a remote or teleworking position.
Benefits of Working for the State of Florida
Health insurance (individual and family coverage) to eligible employees.
Life insurance; $25,000 policy is free plus option to purchase additional life insurance.
Dental, vision and supplemental insurance.
State of Florida retirement options, including employer contributions.
Ability to earn up to 104 hours of paid annual leave as a new employee with the State of Florida.
Ability to earn up to 104 hours of sick leave annually.
Nine paid holidays and 1 personal holiday each year.
Opportunities for career advancement.
Tuition waivers (accepted by major Florida Colleges/universities).
Student loan forgiveness opportunities (eligibility required).
Shared Savings Program for select medical services.
Lower copays for prescription drugs.
Health and Wellness discounts.
For a more complete list of benefits, please visit
mybenefits.myflorida.com .
For more information about the Bureau of Plan Management Operations, please visit our website at
ahca.myflorida.com .
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
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).
Knowledge of the techniques used in compiling and analyzing data.
Ability to collect, evaluate and analyze data to develop alternative recommendations, solve problems, document workflow and other activities related to the improvement of operations.
Ability to organize data in a logical format for presentation in reports, documents 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 relating to operational activities.
Ability to make decisions in a timely manner.
Ability to verify accuracy of data.
Ability to establish and maintain effective working relationships with all levels of staff.
Possesses effective verbal and written communication skills.
Ability to travel with or without accommodation.
MINIMUM QUALIFICATIONS REQUIREMENTS
Two (2) years of experience in medical claims billing or medical claims processing with understanding of the Explanation of Payment and Explanation of Benefit Statements for health insurance companies/government healthcare related programs.
Two (2) years of experience researching and interpreting policies and procedures.
Two (2) years of experience using Microsoft Office (Outlook, Word, Excel, etc.) and various software programs.
One (1) year experience auditing or conducting monitoring of medical claims activities related to a healthcare program.
LICENSURE, CERTIFICATION, OR REGISTRATION REQUIREMENTS N/A
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 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 should 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.
Location FT LAUDERDALE, FL, US, 33309
Nearest Major Market: Fort Lauderdale
Nearest Secondary Market: Miami
For assistance, call the People First Service Center at 877-562-7287 Monday - Friday, 8:00 a.m. to 6:00 p.m., Eastern time.
#J-18808-Ljbffr