State of Florida · 1 day ago
68064720 - GOVERNMENT OPERATIONS CONSULTANT III
Tallahassee, FL
Part-time
Onsite
Mid Level
4+ years expThe State of Florida's Agency for Health Care Administration is seeking a Government Operations Consultant III to enhance the delivery of health care services through the Florida Medicaid Program. This role involves monitoring, evaluating, and analyzing Medicaid program fiscal operations, as well as developing audit programs and software applications for data management.
Government Administration
Responsibilities
Planning and coordinating the tasks of monitoring, evaluating and analyzing the efforts of the Medicaid program fiscal agent relative to mainframe computer processing of claims submitted by Medicaid providers
Assists in the development of specifications and audit programs for data applications software for the transfer of extracted data to micro-computers for evaluation, error identification and corrective action statements to the fiscal agent and advises higher level management on problems/issues and resolutions
Directs the monitoring of a review of each audit engagement or review assignment upon completion by audit staff and prepares reports to document findings and make recommendations for improvement to appropriate agency personnel regarding program policy weaknesses and claim processing deficiencies
The report also contains recommendations to the Medicaid fiscal agent of procedural or computer systems changes relative to inappropriate adjudication and for payment recoupment
Prepares quarterly reports identifying overpayments and recoupments due to audit findings
Reviews responses to audit findings received from the Medicaid fiscal agent, making determinations to their sufficiency and updates outstanding audit findings tracking log
Confers with agency and user organization management regarding findings, questions and recommendations developed as a result of each unit engagement/review assignment
Develops and maintains microcomputer software applications for tracking audit findings resolution
In consultation with the Office of Medicaid Fiscal Agent Operations, conducts routine or special independent audits of a moderately complex nature of all parties involved in the processing of Medicaid claims by the Medicaid fiscal agent and consults with staff to determine compliance with Medicaid program policy; including testing of computerized claims processing systems for accuracy, preparation of specifications and parameters of special reports for audit applications
Implements policies and procedures of the agency and the audit and program analysis functions within the section
Performs other functions considered necessary to continually upgrade the professional competency of the professional staff of the section
Perform a quarterly review of the Forced/Denied Report (FLMC6500-R021) and Services Force Paid by Claims Examiners (FLMC 6500-R015) and report any system or adjudication errors to the supervisor
Cooperates with and assists state and federal auditors in the conduct of their examinations
Assists agency’s Report Card coordinator in reviewing documentation supporting sample items selected for the report card review
Also, conducts in-house reviews as determined necessary by the coordinator
Maintains up-to-date knowledge concerning the Florida Medicaid program, including pertinent statutes, Florida State Plan for Medicaid, Florida administrative rules and regulations, program manuals and operations of the Medicaid fiscal agent
Reviews draft policy manuals, billing guidelines, and administrative rule changes, provides comments to appropriate unit
Responsible to Regulatory Analyst Supervisor requests for evaluation of fiscal analysis associated with the Health Insurance Portability and Accountability Act (HIPAA)
Act as agency contract manager for assigned Medicaid contracts, which shall include but may not be limited to the following functions: Maintain active agency contract manager certification; Adhere to established agency procurement policies and procedures; Participate in the competitive and non-competitive procurement and development of assigned contracts; Oversee the day-to-day administrative, programmatic, and financial operations of assigned contracts; Enforce performance of assigned contract terms and conditions; Perform contract monitoring of vendor performance at least annually; Maintain appropriate and up-to-date contract files; and Serve as liaison with assigned contract vendor(s)
Ad hoc request as needed
Performs other duties as assigned
Qualification
Required
One year of professional experience working with accounting systems or financial databases
Three years of experience related to banking, accounting, auditing, mathematics, or financial analysis
Four years of experience using Microsoft Excel, Word, and Outlook
Ability to communicate effectively, both verbally and orally
Ability to formulate policies and procedures
Ability to work independently
Ability to collect and analyze financial data
Ability to utilize problem solving techniques
Knowledge of methods of data collection and analysis
Knowledge of FMMIS operating system
Knowledge of bank reconciliation
Knowledge of accounting systems or financial databases
Preferred
A bachelor's degree or a more advanced degree from an accredited college or university with a focus in a business-related field such as accounting, finance, or mathematics
Medicaid, FMMIS, and/or contract management experience
Benefits
Health insurance (i.e., 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)
Training opportunities
Flexible Spending Accounts
Shared Savings Program for select medical services
Lower copays for prescription drugs
Health and Wellness discounts
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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