68022240 - SENIOR HUMAN SERVICES PROGRAM SPECIALIST

State of Florida

20h•Onsite

About The Position

The Agency for Health Care Administration (AHCA) is Florida's chief health policy and planning entity, 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. Under the direction of the Agency Secretary, AHCA is focused on advancing Governor DeSantis’ vision for Florida’s health care system to be the most cost-effective, transparent, and high-quality health care system in the nation. The Medicaid program provides low-income families and individuals with access to health care. AHCA invites individuals to apply to become an essential member of its team, serving millions across the state. 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 is a professional position in the Medicaid Helpline Contact Center, within the Bureau for Recipient and Provider Assistance (RPA) within the Division of Medicaid, Agency for Health Care Administration (Agency). The incumbent in this position performs professional work in the Medicaid Contact Center, which includes performing as a Choice Counselor for the Statewide Medicaid Managed Care (SMMC) programs and attending Medicaid RPA Outreach events. This position is not a remote or telework position.

Requirements

Two years of experience providing a professional level of customer service in a fast-paced consumer centric environment.
Knowledge of, or ability to learn, detailed Medicaid policies and procedures.
Knowledge of, or ability to learn, Statewide Medicaid Managed Care programs (MMA, LTC, and F-F-S, etc.).
Knowledge of, or ability to learn, Contact Center policies and procedures, including Choice Counseling.
Knowledge of, or ability to learn, several computer-based systems and programs such as HT, FMMIS, Genesys, Outlook, Excel, Word, SharePoint, People First, etc.
Basic knowledge of medical terminology.
Knowledge of correct spelling, grammar, and punctuation.
Excellent communication skills, both verbal and in writing, including skills listening, understanding, and explaining complex, technical, or confidential information.
Efficient time management, organizational, and multi-tasking skills.
Professional interpersonal skills in both one-on-one and in group settings.
Professional telephony skills in a high call volume setting.
Proficient computer typing and/or keyboarding skills.
Analytical and problem-solving skills.
Abilities to meet deadlines and to work well under pressure.
Ability to handle sensitive information and adhere to confidentiality requirements.
Ability to follow instructions.
Ability to learn and to apply knowledge.
Ability to adapt to changes.
Ability to maintain professional and effective working relationships.
Ability to travel with or without accommodation.

Nice To Haves

Moderate to extensive experience and abilities using different computer programs such as Excel, Outlook, and Word, etc., including quick and accurate typing/keyboarding skills.
Six months experience in a Medicaid call center or high-volume setting.
Bilingual (English/ Spanish) language skills.

Responsibilities

Answer an ongoing pro-rata share of recipient, provider and escalation calls, per the need of the Agency, and assignments, including assigned tasks, special projects and initiatives, as assigned, and to meet established performance measures and contact center metrics.
Maintain high quality and professional consumer service standards.
Handle all calls with respect and dignity, listen carefully, maintain confidentiality, and provide unbiased information.
Provide unbiased education and assistance when enrolling potential enrollees into a participating Health Plan and PCP provider as requested (as a Choice Counselor).
Verify identity to ensure HIPAA confidentiality is met.
Explain what plans are available and what additional benefits are offered, what populations are covered, whether the enrollment is mandatory or voluntary.
Educate the enrollee about options during open enrollment and lock-in periods, how to access services and how to contact their plan.
Assist enrollees in mediating or resolving complaints and grievances through direct intervention, referral, or escalation.
Answer questions and educate Medicaid recipients and the general public in a timely, unbiased manner about the (SMMC) programs, Medicaid covered services, and available Health Plan choices.
Enter all enrollment activity and log all interactions into the appropriate system (i.e., Health Track), using the correct documentation and call reasons.
Arrange for necessary translation assistance at the time of call, including: TDD or TYY and Interpreter Vendor services.
Refer complaints, requests for fair hearings, and escalation issues, etc. timely and appropriately.
Maintain up to date knowledge concerning the Florida Medicaid Program; pertinent federal laws and regulations, state statutes and rules; the Florida Medicaid State Plan and its amendment processes; Medicaid Managed Care Waivers; and Medicaid program manuals.
Remain informed about Choice Counseling procedures, including the For Cause process.
Remain informed about the operations of the Medicaid fiscal agent.
Remain informed about Medicare, Medicaid, and related programs, research and demonstration projects, innovations for special populations, alternative financing and service delivery systems models, etc.
Maintain knowledge about the Medicaid State Plan, waivers, regulations, and processes.
Maintain up-to-date knowledge concerning the Florida Medicaid program, including Medicaid managed care and Fee-for-service (FFS) programs, operational guides, related plan communications, Medicaid program handbooks, Medicaid systems and technology, Medicaid Fiscal Agent and Enrollment Broker operations, regulations of the Agency for Health Care Administration policies and procedures, initiatives, news and updates, and Medicaid-related activities of the Agency, recipient enrollment in managed care plans, policies and procedures relating to Medicaid covered services, the roles of choice counseling, and Medicaid contact center operational procedures.
Participate in Agency training opportunities and engage in self-education utilizing available resources.
Know how to search for pertinent federal laws and regulations, applicable state statutes and Medicaid rules, as needed.
Remain 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.

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