- 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
- Substantial knowledge of the principles and techniques of research and analysis.
- Knowledge of data and programmatic analysis.
- Knowledge and experience in regulatory oversight.
- Knowledge and/or experience with the Medicaid program.
- Knowledge of understanding when referring to general medical terminology.
- Ability to coordinate with other staff, peer reviewers, and make recommendations based on analysis.
- Ability to review and comprehend applicable federal and state laws, rules, and policies related to health care and enforcement activities.
- Ability to apply this knowledge to assist MPI in appropriately conducting investigations, making referrals to other entities, recovering overpayments, applying administrative sanctions, and processing final orders involving Medicaid providers.
- Ability and able to travel with or without accommodations.
- Proficient in use of Microsoft Office.
- One year of professional investigative, health care, or Medicaid experience in a position within a regulatory, or health service setting.
- A bachelor's degree from an accredited college or university is preferred, particularly in a related field such as: health law, health science, health services administration, business administration, public administration, sociology, criminology, criminal justice, or a substantially similar discipline.
- Experience as described above can substitute on a year-for-year basis for the preferred college education.
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senior human services program specialist - Tallahassee, United States - State of Florida
Description
Requisition No:
Agency:
Agency for Health Care Administration
Working Title:
SENIOR HUMAN SERVICES PROGRAM SPECIALIST
Pay Plan:
Career Service
Position Number:
Salary:
$1,551.96 biweekly
Posting Closing Date: 05/13/2024
Total Compensation Estimator Tool
Agency Overview:
The Agency for Health Care Administration 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.
Position Overview:
This is a great opportunity within the Agency's Bureau of Medicaid Program Integrity (MPI).
MPI serves as the primary organizational unit within the Agency that is responsible for prevention, detection, and recoupment/enforcement related to Medicaid program oversight, as well as the lead unit for compliance with contractual and statutory requirements related to fraud and abuse activities.
This role requires a highly motivated person looking to expand their knowledge. This is a full-time career service position, with regularly scheduled hours of Monday-Friday 8:00 a.m. to 5 p.m.The Senior Human Services Program Specialist is to be filled at a rate of $1,551.96 bi-weekly/non-negotiable. This position may involve travel-related activities from 1-15%.
The Agency requires background and fingerprint screening as a condition of employment.
The Florida Medicaid program is one of the five largest in the country and has an estimated $38 billion annual budget.
To effectively serve this large patient population, one of the Agency goals is to ensure fewer budgeted dollars are lost to fraud, abuse, and waste.
The Bureau of Medicaid Program Integrity (MPI) does this specifically through audits and investigations of healthcare providers, including managed care plans, suspected of engaging in fraudulent or abusive behavior, as well as overpayment recoveries, administrative sanctions, and the referral of suspected fraud or other criminal violations for law enforcement investigation.
The Senior Human Services Program Specialist position will support the fraud and abuse prevention efforts within MPI.The position incorporates all the functions that fall within the Bureaus' responsibility and works with the various units in MPI.
The incumbent will be responsible for the coordination of program activities while supporting the operations of unit and bureau administrative activities and is expected to work both independently and in a group setting to complete work assignments related to bureau needs.
This position will be privy to sensitive information and the incumbent is expected to maintain information in the strictest confidence.
The work involves a range of advanced level administrative and operational activities to support the protocols in place specific to MPI's mission of preventing fraud and abuse in the Florida Medicaid system.
This position conducts and assists in investigations and audits with the responsibility of maintaining and tracking case files.
The incumbent will be responsible for participating in identifying and processing actions against providers to include sanctions, fines, suspensions, and terminations.
A solid knowledge of the Florida Medicaid system is critical for this position.
The position is also responsible for coordination of meetings, training, projects, bureau record retention and maintaining bureau files consistent with the State of Florida, AHCA, and bureau protocols.
Excellent organizational, administrative, and communicative skills are key, as this position coordinates and collaborates with the entire bureau, Health Quality Assurance division, Agency personnel, as well as Medicaid providers.
Effective research and analytical skills are vital in this 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:
KNOWLEDGE, SKILLS, AND ABILITIES
N/A
CONTACT: HELEN GUNN
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 Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.
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.
