Medicaid Program Integrity Jobs in Boca Raton, FL

This position is not a Telework position and is required to report to the APD office in the area it serves. The 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 eligible employees features a highly competitive set of employee benefits, including: Annual and Sick Leave benefits. Nine paid holidays and one Personal Holiday each year. State Group Insurance coverage options, including health, life, dental, vision, and other supplemental insurance options. Retirement plan options, including employer contributions (For more information, please click www.myfrs.com ). Flexible Spending Accounts. Tuition waivers. And more! For a more complete list of benefits, visit www.mybenefits.myflorida.com . Paid Maternity and Parental Leave. Position Summary This is a professional position responsible for independently performing a variety of duties related to quality improvement and enhancement of provider service delivery practices, training and technical assistance, researching provider related complaints, ensuring providers who are not in compliance submit and follow a plan of remediation which is responsive to cited deficiencies, directing providers to the Agency for Health Care Administration (AHCA) when billing discrepancies are identified, documenting communication with providers and stakeholders to address identified concerns, collaborating with external stakeholders including the Quality Improvement Organization (QIO), Medicaid Program Integrity (MPI) and the Medicaid Fraud Control Unit (MFCU) as while upholding HIPAA requirements. The Work You Will Do Review the QIO reports and identify deficiencies needing correction. Notify the provider of deficiencies needing correction and provide a plan of remediation template for provider completion. Review the provider plan of remediation to ensure all deficiencies are remediated within required timeframes and add remediation activities onto the remediation tracker. Follow up with the provider to ensure all rights and health and safety alerts are addressed within required timeframes. Follow up on any provider complaints received. Ensure any identified client health and safety issues are immediately addressed. Require a plan of remediation for all verified complaints. Add the complaint onto the remediation tracker. Assist in completion of the Provider Adverse Action Request Form for request for administrative complaints or provider terminations. Ensure that a Corrective Action Plan is generated for all deficiencies involving APD licensed facilities in annual QIO reviews. Collaborate with the APD waiver team and clinical team in researching complaints. Collaborate with external agencies (MPI, QIO, MFCU) in addressing provider performance concerns. Perform other related duties as assigned. Minimum Qualifications Highschool Diploma or its equivalent. Valid Driver's license or other efficient means of transportation and willing to travel for work purposes. Knowledge, Skills, And Abilities Knowledge of: Microsoft Office Programs (Word, Excel, Outlook, Teams, SharePoint). iConnect to complete business processes. Ability to: Provide responsive customer service. Work with individuals with developmental disabilities. Multi-task effectively. Use tracking systems to monitor and complete work assignments within required timeframes. Travel to complete wellness visits, attend provider quarterly meetings, attend other meetings as assigned. Additional Information Retiree Notice If you are a retiree of the Florida Retirement System (FRS), please check with the FRS on how your current benefits will be affected if you are re-employed with the State of Florida. Your current retirement benefits may be suspended or voided, and you will be required to repay all benefits received depending upon your retirement date. Direct Deposit Program As a condition of employment, a person appointed to a position in the State Personnel System is required to participate in the Direct Deposit Program. Rather than receiving a paper paycheck, your funds will be deposited directly into your account at your financial institution. This will be accomplished by Electronic Funds Transfer. Banks, savings and loan associations, and credit unions are eligible to accept such deposits. Retirement funds are also required to be in the Direct Deposit Program. Background Screening Requirement It is the policy of the Florida Agency for Persons with Disabilities that applicants for employment undergo Level 2 employment screening in accordance with the requirements of Chapter 435, Florida Statutes, as a condition of employment or being permitted to serve as a volunteer. No applicant for a designated position will be employed or permitted to volunteer until the Level 2 screening results are received, reviewed, and approved by the Agency. Level 2 background screening shall include, but not be limited to, fingerprinting for Statewide criminal and juvenile records checks through the Florida Department of Law Enforcement and Federal criminal records checks through the Federal Bureau of Investigation and may include local criminal records checks through local law enforcement agencies. Pursuant to S. 110.1127(1), Florida Statutes, this position requires a background investigation, including fingerprinting. APD only hires U.S. citizens and those lawfully authorized to work in the U.S. APD participates in the U.S. government's employment eligibility verification program (E-Verify), which electronically confirms an employee's eligibility to work in the U.S. after completing the employment eligibility verification form (I-9). All applicants should complete the online application process. If you need assistance applying for this position, please call the People First service center at 1-877-562-7287. Responses to the qualifying questions are required to be considered for this position. Answers to the qualifying questions must be verifiable based on your submitted application. 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: WEST PALM BEACH, FL, US, 33401