68900227 - OPS SR HUMAN SERVICE PROGRAM SPECIALIST

Requisition No: 843663 

Agency: Agency for Health Care Administration

Working Title: 68900227 - OPS SR HUMAN SERVICE PROGRAM SPECIALIST

 Pay Plan: Temp

Position Number: 68900227 

Salary:  $17.53 - $18.00 Hourly 

Posting Closing Date: 01/02/2025 

Total Compensation Estimator Tool

Agency Overview:

The Agency for Health Care Administration 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.

Position Overview:

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 hourly, 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 Prevention Strategy Unit is a dynamic and fast-paced unit within MPI that works closely with other units to serve the overall bureau mission.

To address the complexity and scope of fraudulent and abusive behavior in the Florida Medicaid program, the Prevention Strategy Unit is responsible for developing novel methods and technologies to fight fraud, abuse, and waste.

To do this, the highly collaborative and innovative unit relies on a team with diverse educational and experience backgrounds.

This position requires a broad array of knowledge and experience specifically related to fraud prevention programs, compliance assessment, legal analysis, and the investigative process.

The selected candidate will assist in conducting investigations related to fraud, abuse, and waste through research and analysis of complex health and business-related data. 

Included in the functions of this position are activities such as:

•Assisting with investigative activities.

•Utilizing open-source and proprietary resources to conduct the investigations and related administrative actions, as well as monitoring and tracking the associated case status.

•Assisting in preparing referrals to law enforcement entities.

•Identifying, analyzing, and interpreting trends or patterns in data sets, as well as other investigative and research tools.

•Collaborating with team members on projects and assignments.

•Conducting document reviews related to Program Integrity activities.

MPI provides a multitude of training opportunities for all MPI employees to enhance their professional growth. For more information, please visit MPI at: http://ahca.myflorida.com/MCHQ/MPI/index.shtml

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 Other Personal Services (OPS) employees features a highly competitive set of employee benefits including:

•              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)

For a more complete list of benefits and eligibility requirements, visit www.mybenefits.myflorida.com

What is OPS employment?

OPS employment is a temporary employer/employee relationship used for accomplishing short term or intermittent tasks.  OPS employees are at-will employees and are subject to actions such as pay changes, changes to work assignment, and terminations at the discretion of the agency head or designee.

OPS employees do not serve probationary periods or become permanent in their positions because they serve at the pleasure of the agency head.

KNOWLEDGE, SKILLS, AND ABILITIES

Ability to solve problems and make decisions based on available information.

Ability to execute projects and assignments timely and accurately within a fast-paced environment.

Ability to conduct investigations, coordinate investigative activities, and accurately document the result of an investigation.

Ability to conduct fact finding research.

Ability to work independently.

Ability to communicate effectively verbally and in writing.

Ability to review and comprehend applicable federal and state laws, rules, policies, and regulations related to health care and enforcement activities.

Knowledge of the Florida Medicaid Program.

Knowledge of Microsoft features including, Word, Excel, Outlook, and Internet Explorer.

Knowledge of research or investigative principles, practices, and techniques.

Possess investigative skills, research skills, written and oral communication skills, and organizational skills.

Ability to travel with or without accommodations.

MINIMUM QUALIFICATIONS REQUIREMENTS

One year of investigative, enforcement, health care, or professional experience in a position within a regulatory, or oversight setting.

Preference will be given to candidates with a bachelor's degree or higher from an accredited college or university, particularly in a related field such as: health law, health science, criminology, criminal justice, or a substantially similar discipline.

Preference will be given to candidates with a program integrity related professional certification, such as: Certified Fraud Examiner; Accredited Healthcare Fraud Investigator; Certified Financial Crimes Investigator; Certified Insurance Fraud Investigator; or Certified Compliance and Ethics Professional.

LICENSURE, CERTIFICATION, OR REGISTRATION REQUIREMENTS

N/A

CONTACT: HELEN GUNN 850-412-4626

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.