68021869 - SENIOR HUMAN SERVICES PROGRAM SPECIALIST

State of Florida•Fort Myers Beach, FL

1d•$42,561 - $55,330•Onsite

About The Position

The Senior Human Services Program Specialist works in the Bureau of Medicaid Recipient Services (MRS), which serves as a primary point of contact for Medicaid recipients and community members with questions and concerns about Medicaid. The position supports the Florida Medicaid Program and its fair hearing process. It requires creativity, flexibility, innovation, and the ability to thrive in a fast-paced, team-based environment. The position is onsite and is not remote or telework. The incumbent maintains current knowledge of Florida Medicaid, applicable federal and state laws and regulations, Medicaid rules, and Statewide Medicaid Managed Care (SMMC) contracts, plans, and communications. The role assesses and monitors fair hearing requests, coordinates with managed care plans and fee-for-service vendors, and ensures relevant documents and updates are handled according to established procedures. It also reviews submissions to the MedicaidHearingUnit mailbox and researches and responds to legislative and other priority assignments, maintaining communication with constituents as needed. The specialist may represent the Agency in government and community partnerships, outreach events, presentations, boards, planning groups, and social services forums. Other duties may be assigned. Applicants must complete the required State and National criminal history background screening before beginning employment. The position requires travel, with or without accommodation.

Requirements

At least two years of experience providing professional-level customer service in a fast-paced, consumer-centric environment.
Ability to communicate effectively verbally and in writing.
Ability to determine work priorities, assign work, and ensure assignments are completed properly within established timeframes.
Ability to establish and maintain effective working relationships.
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 and Microsoft Office Suite.
Ability to work independently.
Ability to travel with or without accommodation.
Successful completion and approval of required State and National criminal history background screening before beginning employment.

Nice To Haves

Moderate to extensive experience and ability using computer programs such as Excel, Outlook, and Word.
Quick and accurate typing/keyboarding skills.

Responsibilities

Maintain up-to-date knowledge of the Florida Medicaid program through Agency training and available resources, including websites, provider alerts, and MRS SharePoint sites.
Search for pertinent federal laws and regulations, state statutes, and Medicaid rules as needed.
Stay informed about Agency projects and initiatives, SMMC contract provisions and amendments, talking points and guidance, plan subcontractors and TPAs, and Agency all-plan communications.
Assess newly assigned fair hearing requests to verify that issues were correctly entered in the complaint module; correct errors as appropriate and alert the supervisor for staff training purposes.
Search for duplicate active complaint submissions according to current protocol.
Request legal sufficiency documents from the appropriate SMMC plan or fee-for-service vendor for submission to the Office of Fair Hearing (OFH).
Confirm, when appropriate, that disputed services remain in place pending the hearing outcome.
Assign an Agency fair hearing liaison to attend hearings and request respondent evidence from the appropriate party.
Ensure related documents are processed and shared with OFH according to current protocols.
Monitor active fair hearings for appropriate and timely complaint-module updates and alert the supervisor to issues or concerns.
Review assignments received through the MedicaidHearingUnit mailbox to ensure messages and related documents are promptly triaged and processed; alert the supervisor to issues that may prevent or delay processing.
Research and respond to Legislative Assignments, CorrFlow, and other assigned priority issues related to the fair hearing process.
Contact constituents to obtain information as needed and provide updates on actions taken while maintaining communication throughout the process.
Represent the Agency at government and community partnerships, 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.
Perform other duties as assigned.

Benefits

Health insurance, including individual and family coverage for eligible employees.
Free $25,000 life insurance policy, with the 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 State employee.
Ability to earn up to 104 hours of sick leave annually.
Nine paid holidays and one personal holiday each year.
Career advancement opportunities.
Tuition waivers accepted by major Florida colleges and universities.
Student loan forgiveness opportunities, subject to eligibility.
Training opportunities.
Flexible Spending Accounts.
Shared Savings Program for select medical services.
Lower prescription drug copays.
Health and wellness discounts.