68058973 - SENIOR HUMAN SERVICES PROGRAM SPECIALIST

Requisition No: 829100 

Agency: Agency for Health Care Administration

Working Title: 68058973 - SENIOR HUMAN SERVICES PROGRAM SPECIALIST

 Pay Plan: Career Service

Position Number: 68058973 

Salary:  $1,551.96 Biweekly 

Posting Closing Date: 05/23/2024 

Total Compensation Estimator Tool

Agency Overview:

The Agency for Health Care Administration (AHCA) is Florida's chief health policy and planning entity.

The Agency is 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. 

If you have a desire to use your talent and skills at an organization that provides critical services to millions of individuals and families across the state, AHCA invites you to apply to become an essential member of our team.

As one of Florida’s leading state agencies, AHCA’s diverse workforce community of more than 1,400 employees is proud of its efforts to serve the people of Florida.

Agency Objectives:

HIGH QUALITY

Emphasizing quality in all that we do to improve health outcomes, always putting the individual first.

TRANSPARENT

Supporting initiatives that promote transparency and empower consumers in making well informed healthcare decisions.

COST-EFFECTIVE

Leveraging Florida’s buying power in delivering high quality care at the lowest cost to taxpayers.

Position Overview:

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 Bureau of Medicaid Recipient and Provider Assistance (RPA). 

RPA serves as a primary point of contact for enrolled Medicaid providers, Medicaid recipients, and members of the community with questions and concerns about Medicaid.

This position is responsible for providing full-time customer service to a high-volume Contact Center in Orlando, answering recipient and provider questions regarding Medicaid covered services and Choice Counseling regarding the Statewide Medicaid Managed Care (SMMC) programs and make referrals to the appropriate agencies.

The incumbent is responsible for answering an ongoing pro-rata share of recipient and/or provider related calls, per the need of the Agency, and assignments; and to meet established performance measures and contact center metrics.

The incumbent maintains high quality and professional consumer service standards, handles all calls with respect and dignity, listens carefully, maintains confidentiality, and provides unbiased information.

In the role of Choice Counselor, provides unbiased education and assistance when enrolling potential enrollees into a participating Health Plan and PCP provider as requested.

To accomplish this: (1) verifies identity to ensure HIPAA confidentiality is met, (2) explains what plans are available and what additional benefits are offered, what populations are covered, whether the enrollment is mandatory or voluntary and, (3) educates the enrollee about options during open enrollment and lock-in periods, how to access services and how to contact their plan and, (4) assists enrollees in mediating or resolving complaints and grievances through direct intervention, referral, or escalation.

The incumbent in this position answers questions and educates Medicaid recipients and the general public in a timely, unbiased manner about the (SMMC) programs, Medicaid covered services, and available Health Plan choices.

The incumbent enters all enrollment activities and logs all interactions in the appropriate system (i.e., Health Track, Excel, CCMS, etc.), using the correct documentation and call reasons.

They arrange for necessary translation assistance at the time of call, including: TDD or TYY and Language Line Translation services.

Complaints, requests for fair hearings, and escalation issues, etc. are referred timely and appropriately.

The incumbent in this position maintains 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.

Remains informed about Choice Counseling procedures, including the For Cause process.

Remains informed about the operations of the Medicaid fiscal agent.

Remains informed about Medicare, Medicaid, and related programs, research and demonstration projects, innovations for special populations, alternative financing, and service delivery systems models, etc.

Maintains knowledge about the Medicaid State Plan, waivers, regulations, and processes.

Participates in Agency training opportunities and engages in self-education utilizing available resources.

Knows how to search for pertinent Federal laws and regulations, applicable state statutes and Medicaid rules, as needed.

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.

All other duties as assigned.

The hours are 8:30 a.m. to 5:30 p.m. with an hour lunch, Monday through Friday, reporting to the Agency for Health Care Administration Orlando Medicaid Office.

The position will be hired at the base rate of $1,551.96 bi-weekly and is non-negotiable.

This position is not a remote or telework position; it will have to report to a Field Office or the Headquarters in Tallahassee.

Benefits of Working for the State of Florida:

Working for the State of Florida is more than a paycheck. The State’s total compensation package for employees features a highly competitive set of employee benefits including:

• State Group Insurance Coverage Options, including health, life, dental, vision, and other supplemental insurance options;

• Flexible Spending Accounts;

• State of Florida retirement options, including employer contributions;

• Generous annual and sick leave benefits;

• 9 paid holidays a year and 1 Personal Holiday each year;

• Career advancement opportunities;

• Tuition waiver for courses offered by Florida’s nationally ranked State University System;

• Training and professional development opportunities;

• And more!

For more information about the Bureau of Medicaid Recipient and Provider Assistance, please visit our website at http://ahca.myflorida.com/Medicaid/index.shtml.

Join us at the Agency for Health Care Administration in fulfilling our mission to provide “Better Health Care for all Floridians.”

KNOWLEDGE, SKILLS, AND ABILITIES

Knowledge or ability to learn, detailed Medicaid and 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, Human Resources policies and procedures.

Knowledge of, or ability to learn, several computer-based systems and programs such as HT, FMMIS, Genesys Cloud, Ignite, Outlook, Excel, Word, SharePoint, People First, etc.

Basic knowledge of medical terminology.

Possess excellent communication skills, verbal and in writing, including effective listening, understanding, and motivation.

Efficient time management, organizational, and multi-tasking skills.

Professional interpersonal skills in both one-on-one and in group settings.

Telephony skills in a high call volume setting.

Typing and/or keyboarding skills.

Analytical and problem-solving skills.

Abilities to effectively supervise, lead, direct, and motivate individuals and groups.

Abilities to manage, prioritize, and/or delegate work to meet established standards and deadlines.

Abilities to work well under pressure, and to evaluate issues and make decisions quickly and objectively.

Ability to learn and to apply knowledge.

Ability to train and motivate others.

Ability to adapt to and facilitate changes.

Ability to form and maintain professional and effective working relationships.

Ability to work independently or as part of a team.

MINIMUM QUALIFICATIONS REQUIREMENTS

At least two years of experience providing a professional level of customer service in a fast-paced consumer-centric environment.

Preference will be given to the applicant that has:

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 of experience working in a call center or high call volume setting.

Bilingual (English/Spanish) language skills.

LICENSURE, CERTIFICATION, OR REGISTRATION REQUIREMENTS

N/A

CONTACT: DOREATHA HENDERSON 850-595-2313

BACKGROUND SCREENING

It is the policy of the Florida Agency for Health Care Administration that any applicant being considered for employment must successfully complete a State and National criminal history check as a condition of employment before beginning employment, and, if applicable, also be screened in accordance with the requirements of Chapter 435, F.S., and Chapter 408, F.S.  No applicant may begin employment until the background screening results are received, reviewed for any disqualifying offenses, and approved by the Agency.  Background screening shall include, but not be limited to, fingerprinting for State and Federal criminal records checks through the Florida Department of Law Enforcement (FDLE) and Federal Bureau of Investigation (FBI) and may include local criminal history checks through local law enforcement agencies.

The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.

Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.

The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.

VETERANS’ PREFERENCE.  Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans’ Preference will receive preference in employment for Career Service vacancies and are encouraged to apply.  Certain service members may be eligible to receive waivers for postsecondary educational requirements.  Candidates claiming Veterans’ Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code.  Veterans’ Preference documentation requirements are available by clicking here.  All documentation is due by the close of the vacancy announcement.