68900251 - OPS HUMAN SERVICES PROGRAM SPECIALIST

State of Florida • Tallahassee, FL

7d • Onsite

About The Position

This is a full-time Other Personal Services (OPS) position with regularly scheduled hours of Monday-Friday 8:00 a.m. to 5:00 p.m. The Florida Medicaid program is one of the five largest in the country with an estimated $38 billion annual budget, covering medical services for almost 4 million recipients monthly. The Office of Medicaid Program Integrity (MPI) works to ensure fewer budgeted dollars are lost to fraud, abuse, and waste through audits and investigations of healthcare providers, managed care plans, overpayment recoveries, administrative sanctions, and referrals for law enforcement investigation. MPI is organized by functions including Operations, Data Detection, Investigations, Overpayment Recovery, and Managed Care oversight, operating with dynamic and fast-paced units that work closely to serve the bureau's mission. These units are responsible for developing novel methods and technologies to fight fraud, abuse, and waste, relying on teams with diverse educational and experience backgrounds. The candidate selected for this HSPS position will report to the Detection Intake Unit within MPI. This selected candidate is responsible for returning calls to individuals seeking assistance with submitting complaints related to Medicaid provider fraud and abuse. The candidate will support Intake Unit analysts by assisting in generating referrals to other bureaus within the Agency for Healthcare Administration, other state agencies, law enforcement, and/or federal agencies. The position also involves monitoring incoming complaints, contacting individuals for additional information regarding online complaint submissions, and collaborating with team members on assigned projects. The selected candidate is expected to maintain current knowledge of the investigating methodologies and procedures employed by MPI as well as common fraud schemes, patterns, and trends regarding regional and state-specific concerns in health care fraud and abuse. The selected candidate must also maintain current knowledge of the Florida Medicaid program including rules and regulations within the Agency for Healthcare Administration, pertinent contract provisions, statutes and laws, program manuals, provider handbooks, and Medicaid claims processing procedures. This unit is seeking a candidate with experience specifically related to customer service, proficiency in computer applications, clear and effective writing, and the ability to prepare accurate, well-organized documents. The candidate should be adaptable, able to work closely with team members, and adjust to shifting priorities and projects. Included in the functions of this HSPS position are activities such as: Assisting callers with submission of complaints and gathering additional information for complaints received. Receiving mail and additional complaint documents to forward to appropriate staff members in a timely manner. Composing and sending referrals to outside entities as necessitated. Assisting the Intake Manager with monitoring of the complaint inbox. Collaborating with team members on projects and assignments. This position serves a large population of Spanish/Creole speaking customers and employees may be required to perform interpreter duties, if bi-lingual.

Requirements

• Two years of customer service experience.
• Ability to solve problems and make decisions based on available information.
• Ability to execute projects and assignments timely and accurately within a fast-paced environment.
• Ability to work independently.
• Ability to communicate effectively verbally and in writing.
• Ability to review and comprehend applicable federal and state laws, rules, policies, and regulations related to health care and enforcement activities.
• Ability to demonstrate proficiency using Microsoft features including, Word, Excel, Outlook, and Internet Explorer.
• Knowledge of research or investigative principles, practices, and techniques.
• Possess investigative skills, research skills, written and oral communication skills, and organizational skills.
• Successful completion of a criminal background investigation.
• Good attendance record.

Nice To Haves

• High school diploma or its equivalent.

Responsibilities

• Returning calls to individuals seeking assistance with submitting complaints related to Medicaid provider fraud and abuse.
• Supporting Intake Unit analysts by assisting in generating referrals to other bureaus within the Agency for Healthcare Administration, other state agencies, law enforcement, and/or federal agencies.
• Monitoring incoming complaints.
• Contacting individuals for additional information regarding online complaint submissions.
• Collaborating with team members on assigned projects.
• Maintaining current knowledge of investigating methodologies and procedures employed by MPI.
• Maintaining current knowledge of common fraud schemes, patterns, and trends regarding regional and state-specific concerns in health care fraud and abuse.
• Maintaining current knowledge of the Florida Medicaid program including rules and regulations within the Agency for Healthcare Administration, pertinent contract provisions, statutes and laws, program manuals, provider handbooks, and Medicaid claims processing procedures.
• Assisting callers with submission of complaints and gathering additional information for complaints received.
• Receiving mail and additional complaint documents to forward to appropriate staff members in a timely manner.
• Composing and sending referrals to outside entities as necessitated.
• Assisting the Intake Manager with monitoring of the complaint inbox.
• Collaborating with team members on projects and assignments.
• Performing interpreter duties, if bi-lingual, for Spanish/Creole speaking customers.

Benefits

• No state income tax for residents of Florida
• State Group Insurance coverage options (must meet eligibility requirements), including health, life, dental, vision, and other supplemental insurance options
• Savings & Spending Accounts
• 401 (a) FICA Alternative Plan administered through VALIC (tax deferred Retirement Savings Plan)
• Participation in the Florida Deferred Compensation Plan (457b)

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED