68022139 - GOVERNMENT OPERATIONS CONSULTANT II

The Agency for Health Care Administration (AHCA) is seeking a Government Operations Consultant II to work in the Bureau of Medicaid Plan Management Operations. The role involves reviewing Medicaid managed care claim complaints and determining managed care compliance with contract provisions.

Requirements

• 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
• 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

Benefits

• Health insurance (i.e., individual and family coverage) to eligible employees
• 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
• 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