Requisition No: 834971
Agency: Agency for Health Care Administration
Working Title: 68048529 - GOVERNMENT OPERATIONS CONSULTANT II
Pay Plan: Career Service
Position Number: 68048529
Salary: $1,694.62 - $2,203.01 biweekly
Posting Closing Date: 08/21/2024
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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. Current Agency initiatives include implementing Florida’s groundbreaking Canadian Prescription Drug Importation Program, overhauling Florida’s healthcare technological ecosystem, and increasing insight in the cost of health care services.
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 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). PMO is responsible for the primary oversight of Medicaid’s managed care programs, with a focus on the Statewide Medicaid Managed Care (SMMC) program.
The bureau’s primary responsibility is ensuring that the managed care plans meet Medicaid contractual requirements, including the timely provision of medically needed services and provider payment for such services.
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 through the review of claim complaints, claim forms, explanation of benefits, and authorizations in order to make a compliance determination.
Follows established unit policies and procedures to ensure the compliance process is conducted in a consistent manner and reviews findings to ensure they are documented appropriately.
Analyzes compliance issues and makes recommendation for compliance actions when issues are identified in the managed care plan provider reimbursement and claims processes.
Conducts program training to Medicaid managed care plans related to compliance with contract provisions, provider reimbursement and claims processing requirements.
Maintains up-to-date knowledge concerning the Florida Medicaid Program.
Participates in meetings, prepares, and delivers speeches with the Agency, with managed care organizations and other stakeholders.
Represent 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 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
Location: Fort Lauderdale, FL
Posted: Aug. 16, 2024, 4:24 a.m.
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