Government Operations Consultant Ii

- GOVERNMENT OPERATIONS CONSULTANT II

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Requisition No: 864680

Agency:
Agency for Health Care Administration

Working Title:

- 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.

• 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.

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.

• 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…