68063579 - SENIOR HUMAN SERVICES PROGRAM SPECIALIST

State of Florida•Fort Myers, FL

4d•Onsite

About The Position

This is an exciting opportunity to help shape the quality of health care in Florida. We are seeking to hire a Senior Human Services Program Specialist who desires to work to enhance the delivery of health care services through the Florida Medicaid Program. This position requires a candidate who is creative, flexible, innovative, and who will thrive in a fast-paced, team based work environment. This position is located in the Medicaid Complaint Operations Center and Medicaid Fair Hearing Unit. The incumbent in this position processes and monitors Medicaid fair hearings, as assigned. The incumbent in this position also responds to Medicaid issues and concerns, and complaints as it relates to the fair hearing process. This position is responsible for keeping up-to-date knowledge about the Florida Medicaid program by participating in Agency training opportunities and through self-education utilizing available resources, including but not limited to, the Agency’s internal and external web sites, provider alerts, and RPA share point sites. The incumbent knows how to search for pertinent Federal laws and regulations, applicable state statutes and Medicaid rules, as needed. The incumbent remains informed about Agency projects and initiatives by participating in available webinars and staff meetings, and by subscribing to provide alerts. The incumbent remains knowledgeable about Statewide Medicaid Managed Care (SMMC) contract provisions and amendments, SMMC talking points and guidance statements, SMMC plan subcontractors and TPAs, and information shared via SMMC all-plan communications distributed by the Agency. The incumbent completes an assessment of newly assigned fair hearing requests to confirm issues were correctly entered into the complaint module based on the information available. Should errors be identified, the incumbent makes corrections as appropriate and alerts their supervisor for staff training purposes. Searches for duplicate active complaint submissions, per current protocol. The incumbent requests legal sufficiency documents from the appropriate SMMC plan or FFS vendor to submit to the Office of Fair Hearing (OFH). Confirms that disputed services remain in place pending the outcome of the hearing, when appropriate. The incumbent assigns an Agency fair hearing liaison to attend the hearing and requests respondent evidence from the appropriate party. Ensures related documents are processed and shared with OFH, per current protocols. The incumbent monitors active fair hearings to ensure appropriate and timely updates are made in the complaint module, alerting their supervisor of any identified issues or concerns. The incumbent reviews assignments received via the MedicaidHearingUnit box to ensure all messages and related documents are triaged and processed promptly. Alerts their supervisor of any potential issues/concerns regarding these submissions that prevent or delay processing. The incumbent researches and responds to Legislative Assignments, CorrFlow, and other priority issues related to the fair hearing process, as assigned. Contact the constituent to obtain information, as needed. Provides updates on actions taken to resolve the issue while maintaining communication with constituents throughout the process. The incumbent represents the Agency on government and community partnerships, community outreach events, Secret Shopper assignments, Medicaid overview presentations, transportation boards, community alliances, interagency agreement teams, local planning groups, HIV planning councils and social services agency forums as assigned. This position is not a remote or telework position.

Requirements

Ability to communicate effectively, verbally and in writing.
Ability to determine work priorities, assign work and ensure proper completion of work assignments within established timeframes.
Ability to establish and maintain effective working relationships with others.
Ability to investigate, analyze, and resolve complaints.
Ability to organize data into a logical format for presentations, reports, and other written materials.
Ability to provide training to providers, coworkers, and community agencies.
Ability to review and evaluate plans and programs.
Ability to solve problems and make decisions in a timely manner.
Ability to understand and apply applicable rules, regulations, policies, and procedures.
Ability to use databases.
Ability to utilize Microsoft Office Suite.
Ability to work independently.
Ability to travel with or without accommodation.
Two years of experience providing a professional level of customer service in a fast-paced consumer centric environment.

Nice To Haves

Preference will be given to candidates that have moderate to extensive experience and abilities using different computer programs such as Excel, Outlook, and Word, etc., including quick and accurate typing/keyboarding skills.

Responsibilities

processes and monitors Medicaid fair hearings, as assigned
responds to Medicaid issues and concerns, and complaints as it relates to the fair hearing process
keeping up-to-date knowledge about the Florida Medicaid program by participating in Agency training opportunities and through self-education utilizing available resources
search for pertinent Federal laws and regulations, applicable state statutes and Medicaid rules, as needed
remains informed about Agency projects and initiatives by participating in available webinars and staff meetings, and by subscribing to provide alerts
remains knowledgeable about Statewide Medicaid Managed Care (SMMC) contract provisions and amendments, SMMC talking points and guidance statements, SMMC plan subcontractors and TPAs, and information shared via SMMC all-plan communications distributed by the Agency
completes an assessment of newly assigned fair hearing requests to confirm issues were correctly entered into the complaint module based on the information available
Searches for duplicate active complaint submissions, per current protocol
requests legal sufficiency documents from the appropriate SMMC plan or FFS vendor to submit to the Office of Fair Hearing (OFH)
Confirms that disputed services remain in place pending the outcome of the hearing, when appropriate
assigns an Agency fair hearing liaison to attend the hearing and requests respondent evidence from the appropriate party
Ensures related documents are processed and shared with OFH, per current protocols
monitors active fair hearings to ensure appropriate and timely updates are made in the complaint module, alerting their supervisor of any identified issues or concerns
reviews assignments received via the MedicaidHearingUnit box to ensure all messages and related documents are triaged and processed promptly
researches and responds to Legislative Assignments, CorrFlow, and other priority issues related to the fair hearing process, as assigned
represents the Agency on government and community partnerships, community outreach events, Secret Shopper assignments, Medicaid overview presentations, transportation boards, community alliances, interagency agreement teams, local planning groups, HIV planning councils and social services agency forums as assigned

Benefits

Health insurance (i.e., individual and family coverage) to eligible employees
Life insurance; $25,000 policy is free plus option to purchase additional life insurance
Dental, vision and supplemental insurance
State of Florida retirement options, including employer contributions
Ability to earn up to 104 hours of paid annual leave as a new employee with the State of Florida
Ability to earn up to 104 hours of sick leave annually
Nine paid holidays and 1 personal holiday each year
Opportunities for career advancement
Tuition waivers (accepted by major Florida Colleges/universities)
Student loan forgiveness opportunities (eligibility required)
Training opportunities
Flexible Spending Accounts
Shared Savings Program for select medical services
Lower copays for prescription drugs
Health and Wellness discounts