Job Description

Requisition No: 847675Agency: Agency for Health Care AdministrationWorking Title: 68063497 - SENIOR HUMAN SERVICES PROGRAM SPECIALISTPay Plan: Career ServicePosition Number: 68063497Salary: $1,598.52 BiweeklyPosting Closing Date: 03/11/2025Total Compensation EstimatorAgency 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 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 $1,598.52 bi-weekly and is 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 $30 billion annual budget.Each month Florida Medicaid covers medical services for almost 4 million recipients.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 Detection Unit is a dynamic and fast-paced unit within MPI that works closely with other units to serve the overall bureau mission.This Senior Human Services Program Specialist position will report to a supervisor within the Detection Unit and will support the prevention of fraud and abuse efforts within the Bureau of Medicaid Program Integrity.The selected candidate will be responsible for conducting investigations, writing summary reports, and making referrals to other entities involving Medicaid providers in accordance with state and federal rules, laws, and statutes.The selected candidate will also be responsible for working collaboratively with other MPI operational units and participating in special projects.The candidate will also be responsible for utilizing open-source and proprietary resources to conduct the investigations and related administrative actions, as well as monitoring and tracking the associated case status.The unit is seeking a candidate with a broad array of knowledge and experience specifically related to fraud prevention programs, compliance assessment, and the investigative process.MPI provides a multitude of training opportunities for all MPI employees to enhance their professional growth.A good attendance record is essential for any individual in this position as the work involved occurs daily and istime sensitive. The individual in this position is expected to report to work daily and on time.This position offers an excellent array of benefits, including: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, please visit MPI at: http://ahca.myflorida.com/MCHQ/MPI/index.shtmlKNOWLEDGE, SKILLS, AND ABILITIES

• Substantial knowledge of the principles and techniques of research and analysis.

• Knowledge of data and programmatic analysis, and completion of desk audits.

• Knowledge and experience in Medicaid 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 to travel with or without accommodations.

• Proficient in use of Microsoft Office

MINIMUM QUALIFICATIONS REQUIREMENTS

• 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.

• Professional or nonprofessional experience can substitute on a year-for-year basis for the preferred education.

LICENSURE, CERTIFICATION, OR REGISTRATION REQUIREMENTSN/ACONTACT: HELEN GUNN 850-412-4626BACKGROUND SCREENINGIt 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 . All documentation is due by the close of the vacancy announcement.Location:TALLAHASSEE, FL, US, 32308

State of Florida