State of Florida · 1 month ago
68064264 - GOVERNMENT OPERATIONS CONSULTANT II
Fort Lauderdale, FL
Full-time
Onsite
Entry, Mid Level
2+ years expThe State of Florida's Agency for Health Care Administration (AHCA) is seeking a Government Operations Consultant II to enhance the delivery of health care services through the Florida Medicaid Program. This role involves overseeing Medicaid managed care programs, ensuring compliance with contractual requirements, and analyzing claims and provider reimbursement issues.
Government Administration
Responsibilities
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
Qualification
Required
Two (2) years of experience in medical claims billing or medical claims processing with the understanding of the Explanation of Payment and Explanation of Benefit Statements for health insurance companies/government healthcare related programs
One (1) year experience auditing or conducting monitoring of medical claims activities related to a healthcare program
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
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 work flow 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 accommodations
Benefits
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!
Company
State of Florida
The State of Florida is an online telephone and email directory for state government agencies and employees in Florida.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Richard Herstein, MD, MHA, MBA
Chief Hospital Administrator (CEO) and Chief Medical Officer (CMO)
Jimmy Patronis
Chief Financial Officer
Recent News
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