Requisition No: 851003
Agency: Agency for Health Care Administration
Working Title: 68064785 - GOVERNMENT OPERATIONS CONSULTANT II
Pay Plan: Career Service
Position Number: 68064785
Salary: $1,694.62 - $2,452.11 biweekly
Posting Closing Date: 04/27/2025
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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 Program Finance (MPF). MPF manages and projects Florida’s $34.5 billion Medicaid Services budget, oversees financial reporting of the Agency’s contracted Medicaid health plans, calculates both institutional and non-institutional Medicaid reimbursement rates, and disburses supplemental payments to Medicaid providers.
This position is responsible for setting reimbursement rates in accordance with Medicaid reimbursement plans, policies, and applicable federal and state rules and regulations. The incumbent will also be responsible for maintaining the Versa database and Laserfiche files for the bureau. It is necessary to understand and comprehend the significance of complicated legal documents and to have a working knowledge of the diverse organizational programmatic aspects of AHCA for this position. Duties and responsibilities involving complex work assignments with minimum instructions include, but are not limited to, the following:
Enter notices, final orders, and disposition (including other relevant information) in Versa/FRAES including all relevant fields. Create Audit Transmittal Memos for Nursing Homes, ICF, and Hospitals. Manage the production of all annual Nursing Home reports. Analyze and review nursing home provider budgeted cost reports and make appropriate adjustments to establish an interim budgeted rate. Set facility rates in accordance with Medicaid reimbursement plans and policies and applicable federal and state rules and regulations. Establish the initial FRVS asset base for new or replacement nursing home facilities. Identify the need for and obtain additional information and cost data from providers in order to set a facility’s initial rate. Prepare cost report computer input sheets for all provider preliminary desk audits. Forward the initial budgeted rate notices to the appropriate Medicaid offices and to the fiscal agent. Calculation of depreciation/indexing recapture amounts and notification of providers and appropriate bureaus within the Agency in order to collect any calculated recaptures.
Open, update and close cases in Versa/FRAES when appropriate. Assist setting facility rates in accordance with Medicaid reimbursement plans and policies and applicable federal and state rules and regulations. Coordinate all the activities necessary for the semi-annual (or annual, if mandated) rate settings for all nursing home providers enrolled in the Medicaid program. Update facility rates as audit and licensure results are made available. Review and analyze requests from Medicaid providers for rate adjustments and determine if a rate increase should be authorized. Calculate and set rates for the settlement of Medicaid interim reimbursement rates when the initial cost report becomes available. Verify that all rate changes are made correctly by the fiscal agent, and retroactive payments or adjustments are made appropriately by the fiscal agent for all rates the analyst is responsible for. Determination and update of lease bonds and lease bonds alternative amounts for nursing facilities, and review of lease bond alternative fund to determine adequacy of funding levels in comparison to overpayments to leased facilities.
Provide technical assistance and training to new staff. Consult with attorneys and other Agency staff when needed. Provide technical assistance and consultation to the public and other offices as appropriate, ensuring AHCA policies are accurately represented. Process incoming mail and regularly correspond with unit offices. Provide technical assistance and consultation to departmental staff, provider association, and other organizations and interested persons regarding policies and procedures for provider rate setting; assist in the preparation of informational and educational material on Medicaid provider rate setting; and assist in the development and implementation of cost reimbursement rate setting training programs.
Coordinates and maintains an efficient intake processing system of documents related to the job function. Examples include compiling and processing necessary documents for default final order of MPF cases. Maintain up-to-date knowledge concerning the Florida Medicaid program, including pertinent statutes, Florida rules, regulations of the Department of Health and Human Services, provider manuals, and Medicaid billing procedures. Remain informed about Medicaid activities of the Agency for Health Care Administration and about operations of the fiscal agent contractor. Maintain detailed knowledge of Medicaid financial and statistical information at both state and national levels. Maintain detailed knowledge of Medicare and other health care program cost reimbursement principles and the Medicaid cost reimbursement and rate setting methods of other states. Remain informed about health care cost containment issues on the local, state and national level. Maintain detailed knowledge of accepted accounting and auditing principles, procedures, and techniques. Assist in preparing special reports and analyses on provider costs and the fiscal effect of the primary features of the nursing home cost reimbursement plan including the payment mechanism, rates, grouping criteria, caps, cost projections, inflation allowances, cost allocation, rate revision frequency, geographic differentials, rate appeals, cost reports, allowable costs, depreciation, quality of care incentives, and profit allowances.
Process retroactive rate adjustments for nursing home, ICF, or Hospital assignments. Maintain up-to-date knowledge concerning the Florida Medicaid program, including pertinent statutes, Florida rules, regulations of the Department of Health and Human Services, provider manuals, and Medicaid billing procedures. Remain informed about Medicaid activities of the Agency for Health Care Administration and about operations of the fiscal agent contractor.
Assist in the development of long-range plans for policy and procedures development, implementation and monitoring of cost reimbursement rate setting and analysis activities.
Performs other duties such as necessary.
This position reports to the Headquarters in Tallahassee.
This position is pending a reclass.
This position is not a remote or telework position.
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 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!
For more information about the Bureau of Medicaid Program Finance, please visit our website at http://ahca.myflorida.com/Medicaid/index.shtml.
Join us at the Agency for Health Care Administration in fulfilling our mission to provide “Better Health Care for all Floridians.”
KNOWLEDGE, SKILLS, AND ABILITIES
Knowledge of accounting principles and procedures.
Knowledge of the principles and techniques of effective written and verbal communications.
Knowledge of basic mathematics and economics.
Knowledge of financial forecasting techniques.
Intermediate knowledge of Excel, Outlook, and Microsoft Word.
Ability to use a calculator and a computer terminal.
Ability to adequately document work assignments completed.
Ability to prepare audit reports.
Ability to conduct research and investigations.
Ability to review, analyze and evaluate financial and operational data.
Ability to audit financial forecasted statements.
Ability to compile statistical data.
Ability to understand and apply laws, rules, regulations, policies, and procedures.
Ability to process and respond to consumer complaints.
Ability to verify the accuracy of numerical data.
Ability to plan, organize and coordinate work assignments.
Ability to communicate effectively verbally and in writing
Ability to establish and maintain effective working relationships with others.
Ability to prepare financial statements.
Ability to utilize problem solving techniques.
MINIMUM QUALIFICATIONS REQUIREMENTS
Four years of professional experience related to accounting, mathematics, auditing, or financial analysis.
Two years of professional experience using Microsoft Excel, Word, and Outlook.
Bachelor’s degree from an accredited college or university with a degree in a field such as accounting, finance, or mathematics being highly preferred.
Detailed knowledge of generally accepted accounting and auditing principles, procedures, and techniques is preferred.
LICENSURE, CERTIFICATION, OR REGISTRATION REQUIREMENTS
N/A
CONTACT: YNDIA RUTLAND (850) 412-4101
BACKGROUND SCREENING
It is the policy of the Florida Agency for Health Care Administration that any applicant being considered for employment must successfully complete a State and National criminal history check as a condition of employment before beginning employment, and, if applicable, also be screened in accordance with the requirements of Chapter 435, F.S., and Chapter 408, F.S. No applicant may begin employment until the background screening results are received, reviewed for any disqualifying offenses, and approved by the Agency. Background screening shall include, but not be limited to, fingerprinting for State and Federal criminal records checks through the Florida Department of Law Enforcement (FDLE) and Federal Bureau of Investigation (FBI) and may include local criminal history checks through local law enforcement agencies.
The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.
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.
