68900227 - OPS SR HUMAN SERVICE PROGRAM SPEC

State of Florida • Tallahassee, FL

2d • $18 - $18

About The Position

This is a full-time OPS position, with regularly scheduled hours of Monday-Friday 8:00 a.m. to 5 p.m.
This OPS Senior Human Services Program Specialist position is anticipated to be filled at a rate of $17.53 - $18.00 per hour, based on the selected candidate's qualifications and experience.
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 the top five largest in the country and has an estimated $38 billion annual budget. Each month Florida Medicaid covers medical services for almost 4 million recipients.
To most 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 suspected of engaging in fraudulent or abusive behavior, as well as overpayment recoveries, administrative sanctions, and the referral of suspected fraud or other criminal activities for law enforcement investigation.

The Sanctions & Enforcement Unit is a fast-paced unit within MPI that works collaboratively with internal and external partners to ensure fair, consistent, and defensible enforcement of program requirements.
The unit plays a key role in program integrity efforts by reviewing audit findings, analyzing information, evaluating compliance with, and applying applicable state and federal laws, rules, and policies to recommend and impose sanctions against Medicaid providers.
Staff prepare and issue sanction notices, and manage cases through the sanction process, including actions that proceed through the final order stage. 

This OPS position provides support to the sanctions process by assisting with case tracking, quality review, and documentation management. 
The role involves monitoring statutory timelines, including required notice periods, ensuring case files and supporting documentation are accurately maintained in the case tracking system, and assisting with the preparation and quality review of sanction notices and final orders. 
The role also includes gathering documents and information from internal systems and online sources and assisting with investigative activities related to sanctions, including the preparation of investigative summaries or reports. 
Attention to detail, organization, and the ability to manage multiple tasks are critical to supporting timely and legally sound sanction actions.

MPI provides a multitude of training opportunities for all MPI employees to enhance their professional growth.

Requirements

• Knowledge of understanding office procedures, records management, and documentation standards.
• Ability to organize, track, and maintain multiple case files while meeting required deadlines and timelines.
• Ability to follow established procedures and apply rules, policies, and guidance accurately.
• Awareness of confidentiality requirements and the importance of safeguarding sensitive information.
• Skill in using computer applications such as case tracking systems, databases, word processing, and spreadsheets.
• Skill in written communication sufficient to prepare summaries, reports and documentation for review.
• Ability to work collaboratively with team members and communicate effectively with supervisors.
• Knowledge of research methods and information gathering from internal systems and online sources.
• Knowledge of Microsoft features including Word, Excel, and Outlook.
• Skill in reviewing documents for accuracy, completeness, and consistency.
• Ability to monitor statutory or required timelines and flag issues or discrepancies.
• Ability to travel with or without accommodations.
• One year of professional or nonprofessional experience in a role involving research, records review, compliance, investigations, audits, casework, or analytical work.

Nice To Haves

• Preferences may be given to candidates who have completed coursework toward, or obtained, an associate’s degree or higher from an accredited college or university.
• Preference will be given to candidates with professional certifications related to compliance, auditing, research, data analysis, or program support functions.

Responsibilities

• assisting with case tracking
• quality review
• documentation management
• monitoring statutory timelines, including required notice periods
• ensuring case files and supporting documentation are accurately maintained in the case tracking system
• assisting with the preparation and quality review of sanction notices and final orders
• gathering documents and information from internal systems and online sources
• assisting with investigative activities related to sanctions, including the preparation of investigative summaries or reports

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: Mid Level
• Education Level: No Education Listed