•Assist the Compliance officer with oversight of the Special Investigations Unit (SIU) which includes managing case assignments, case development and review, overpayment recoveries, and state agency and/or law enforcement referrals.•Training of staff and coordination with other departments to mitigate and remedy Fraud, Waste and Abuse.•Monitor compliance with company policies and procedures and compliance with pertinent FWA provisions of the State contract •Ensure the proper and timely submission of the Quarterly Fraud, Abuse and Activity Report (QFAAR) and the Annual Fraud, Abuse and Activity Report (AFAAR).•Manage and maintain the AHCA - Background Screening Clearinghouse for Integral Quality Care.

•Represent the Fraud Prevention and Compliance Unit in Hillsborough. Hardee, Highlands, Polk, and Manatee Counties.•Conduct a variety of on-site provider and recipient visits that often result in activities ranging from provider education and assistance with enrollment and compliance issues to referrals to Medicaid Program Integrity or the Medicaid Fraud Control Unit up to and including recommendation for exclusion from the Medicaid program.•Submit direct referrals to both internal and external entities for violations of statute, rule, or policy that fall within the regulatory responsibilities of that agency.•Conduct special targeted field projects across the State of Florida independently as well as in a team structure.

•Assisted in planning, developing, coordinating, monitoring, and directing activities related to assigned Medicaid programs in Medicaid Area 06.•Assisted in implementation and education of Medicaid policies and procedures related to assigned Medicaid programs including Hospital, Ambulatory Surgical Center, Long Term Care, Hospice, Assistive Care Services, Durable Medical Equipment, End-stage Renal/Dialysis, and various waiver programs under the Medicaid umbrella.•Reviewed, researched, documented, and prepared appropriate claims for force payment resolution.•Monitored, evaluated, and directed assigned programs to ensure compliance with program policies.•Participated in supervisory conferences, staff meetings, training seminars, and workshops.

•Researched and processed medical claims submitted to the area office.•Represented the Agency for Healthcare Administration at various outreach events.•Educated recipients, providers, and the community as to the intricacies of the Medicaid program.•Provided technical assistance to Medicaid staff, providers, and other agencies.