68022240 - SENIOR HUMAN SERVICES PROGRAM SPECIALIST

68022240 - SENIOR HUMAN SERVICES PROGRAM SPECIALIST

Date: Jul 8, 2026 Agency: Agency for Health Care Administration (AHCA) Working Title: 68022240 - SENIOR HUMAN SERVICES PROGRAM SPECIALIST The Agency for Health Care Administration (AHCA) is Florida's chief health policy and planning entity, responsible for administering the Florida Medicaid program, licensing and regulating nearly 50,000 health care facilities, and empowering consumers through health care transparency initiatives. 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 to deliver 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. The Senior Human Services Program Specialist will work in the Medicaid Helpline Contact Center within the Bureau for Recipient and Provider Assistance (RPA) of the Division of Medicaid, Agency for Health Care Administration. The incumbent performs professional work as a Choice Counselor for Statewide Medicaid Managed Care (SMMC) programs and attends Medicaid RPA Outreach events. Responsibilities Answer an ongoing pro‑rata share of recipient, provider, and escalation calls, and perform assigned tasks, special projects, and initiatives. 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, including verifying identity for HIPAA confidentiality, explaining available plans, and educating enrollees about options during open enrollment and lock‑in periods. Assist enrollees in mediating or resolving complaints and grievances through direct intervention, referral, or escalation. Educate Medicaid recipients and the general public about SMMC programs, Medicaid covered services, and available Health Plan choices. Enter enrollment activity and log all interactions into the appropriate system (Health Track) using correct documentation and call reasons. Arrange for necessary translation assistance at the time of call, including TDD or TTY and Interpreter Vendor services. Refer complaints, requests for fair hearings, and escalation issues in a timely and appropriate manner. Maintain up‑to‑date knowledge of the Florida Medicaid Program, pertinent federal laws and regulations, state statutes, the Florida Medicaid State Plan and its amendments, Medicaid Managed Care Waivers, and Medicaid program manuals. Remain informed about Choice Counseling procedures, the For Cause process, Medicaid fiscal agent operations, Medicare, Medicaid, and related programs, research and demonstration projects, and innovations for special populations. Participate in Agency training opportunities and engage in self‑education utilizing available resources. Knowledge, Skills, and Abilities 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‑FS, etc.). Knowledge of, or ability to learn, Contact Center policies and procedures, including Choice Counseling. Knowledge of multiple computer‑based systems and programs such as HT, FMMIS, Genesys, Outlook, Excel, Word, SharePoint, People First, etc. Basic knowledge of medical terminology and correct spelling, grammar, and punctuation. Excellent communication skills, both verbal and written, including listening, understanding, and explaining complex, technical, or confidential information. Efficient time management, organizational, and multi‑tasking skills with professional interpersonal skills in one‑on‑one and group settings. Professional telephony skills in a high call volume setting and proficient computer typing/keyboarding skills. Analytical and problem‑solving skills, ability to meet deadlines, work well under pressure, handle sensitive information, and adhere to confidentiality requirements. Ability to follow instructions, learn and apply knowledge, adapt to changes, maintain professional relationships, and travel with or without accommodation. Minimum Qualifications Requirements Two years of experience providing a professional level of customer service in a fast‑paced consumer‑centric environment. Moderate to extensive experience using different computer programs such as Excel, Outlook, and Word, including quick and accurate typing/keyboarding skills. Six months of experience in a Medicaid call center or high‑volume setting. Bilingual (English/Spanish) language skills preferred. Benefits of Working for the State of Florida Health insurance (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. Ability to earn up to 104 hours of paid sick leave annually. Nine paid holidays and one personal holiday each year. Opportunities for career advancement. Tuition waivers (accepted by major Florida colleges/universities). Student loan forgiveness opportunities (eligibility required). Shared Savings Program for select medical services. Contact: Tiffany Trinidad View phone number on click.appcast.io Background Screening Applicants must successfully complete a State and National criminal history check and any additional screening required by Florida law before beginning employment. Background screening includes, but is not limited to, fingerprinting for State and Federal criminal records checks through the Florida Department of Law Enforcement (FDLE) and the Federal Bureau of Investigation (FBI). Applicants requiring a reasonable accommodation must notify the agency hiring authority or People First Service Center View phone number on click.appcast.io) in advance. Veterans’ Preference Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans’ Preference will receive preference for Career Service vacancies. Certain service members may be eligible to receive waivers for postsecondary educational requirements. Veterans’ Preference documentation, including DD Form 214 Member Copy #4, must be attached to each submission. Documentation requirements are available by visiting the specified source. All documentation is due by the close of the vacancy announcement. For assistance, call the People First Service Center at View phone number on click.appcast.io Monday – Friday, 8:00 a.m. to 6:00 p.m., Eastern time. Pursuant to Florida Law, 110.211 F. S., the State of Florida is an EEO employer. #J-18808-Ljbffr Florida Department of Financial Services