Medical Health Care Program Analyst -
The primary functions of the Medical/Health Care Program Analyst are to oversee the functions regarding Medicaid Fair Hearings (MFH) and to serve as the primary point of contact for the Independent Consumer Support Program (ICSP).
Duties and Responsibilities:
- Maintain a working knowledge of Statewide Medicaid Managed Care Long Term Care (SMMC LTC) including eligibility and enrollment requirements.
- Conduct inbound and outbound calls to SMMC LTC applicants and MFH petitioners, or their representatives, and route calls to appropriate departments and agencies as needed.
- Research and respond to all written correspondence.
- Plan, organize, coordinate, and represent the Department's interest in MFHs for the screening of individuals for possible placement on the Medicaid Home and Community Based Services waitlist.
- Reviews requests for MFHs and documents data and information collected from MFH request, eCIRTS, and other data sources.
- Assigns new cases to self and other staff for completion.
- Conducts pre-hearing conferences with clients/caregivers to discuss the MFH request, and information discovered, with the client and try to address the situation as needed.
- Analyze, prepare, and distribute required evidence to the Office of Appeal Hearings and the client/caregiver within the allotted timeframe.
- Analyze ICSP, Aging and Disability Resource Center (ADRC), and SMMC LTC data to compile regular summary reports and special reports on identified trends, program deficiencies, and recommendations for improvement.
- Provides policy interpretation and technical assistance to headquarters staff, clients/caregivers, and CARES staff on issues related to MFHs and the SMMC LTC Program.
- Interacts and communicates clearly and efficiently with outside entities, including state agencies, local Adult and Disability Resource Centers, and individuals/caregivers.
- Maintains accurate records and updates internal systems to respond to requests for information and data tracking.
- Demonstrates proficiency with eCIRTS, FMMIS, Healthtrack databases for client research to assist with MFHs and ICSP inquiries.
- Coordinates work with other staff members in the unit.
- Assists to resolve waitlist and enrollment issues via client, legislative and gubernatorial inquiries and responds timely.
- Works independently to manage a daily workflow and ensure accurate, timely response, and data entry.
- Follows HIPAA and Information Security protocols/rules and regulations/policies.
- Completes other duties as assigned.
Knowledge, Skills, and Abilities:
- Knowledge of administrative principles & practices.
- Microsoft Office Proficiency, excellent written and verbal communication skills, research skills, attention to detail.
- Ability to conduct fact finding interviews, accurately prepare and maintain records, work with a diverse range of people, adapt well to change, and professionally handle stressful situations.
- Knowledge of office procedures & practices.
- Ability to utilize problem solving techniques.
- Ability to plan, organize & coordinate work assignments.
- Ability to communicate effectively.
- Ability to establish & maintain effective working relationships with others.
Requirements:
- Four years of professional experience in a health-related program, human services, social work, call center, customer service or related field.
- A bachelor's degree from an accredited college or university can substitute for the required experience.
The 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 employee benefits including: State Group Health Insurance Coverage; $25,000 Life Insurance Policy (100% paid by employer); Dental, vision, and other supplemental insurance options available; Annual and Sick Leave benefits, 10 paid holidays each year; Retirement plan options, including employer contributions (For more information, please click Flexible Spending Accounts; and Tuition waivers to attend State of Florida community colleges, colleges, and universities! For a more complete list of benefits, click
Our Organization and Mission:
The Department is dedicated to promoting the well-being, safety, and independence of Florida's seniors, their families, and caregivers. Its vision is for all Floridians to live well and age well.
Applicant Information:
Applicants should apply on-line via the People First Website by 11:59 p.m. (EST) on the closing date of the position vacancy advertisement but are strongly encouraged to apply by 6:00 p.m. on the closing date to avoid any system down times or any other complications that may arise. If you have problems applying on-line, call the People First Service Center at . Paper applications will not be accepted by the agency.
Location: Tallahassee, FL, US, 32301
