Requisition No: 874544
Agency: Agency for Health Care Administration
Working Title: 68022240 - SENIOR HUMAN SERVICES PROGRAM SPECIALIST
Pay Plan: Career Service
Position Number: 68022240
Salary: $1,636.98 - $2,128.07 Biweekly
Posting Closing Date: 07/21/2026
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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 is a professional position in the Medicaid Helpline Contact Center, within the Bureau for Recipient and Provider Assistance (RPA) within the Division of Medicaid, Agency for Health Care Administration (Agency).
The incumbent in this position performs professional work in the Medicaid Contact Center, which includes performing as a Choice Counselor for the Statewide Medicaid Managed Care (SMMC) programs and attending Medicaid RPA Outreach events.
This position is responsible for the incumbent is responsible for answering an ongoing pro-rata share of recipient, provider and escalation calls, per the need of the Agency, and assignments, including assigned tasks, special projects and initiatives, as assigned, 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 activity and logs all interactions into the appropriate system (i.e., Health Track), using the correct documentation and call reasons.
S/He arranges for necessary translation assistance at the time of call, including: TDD or TYY and Interpreter Vendor services.
Complaints, requests for fair hearings, and escalation issues, etc. are referred timely and appropriately.
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.
The incumbent in this position maintains up-to-date knowledge concerning the Florida Medicaid program, including Medicaid managed care and Fee-for-service (FFS) programs, operational guides, related plan communications, Medicaid program handbooks, Medicaid systems and technology, Medicaid Fiscal Agent and Enrollment Broker operations, regulations of the Agency for Health Care Administration policies and procedures, initiatives, news and updates, and Medicaid-related activities of the Agency, recipient enrollment in managed care plans, policies and procedures relating to Medicaid covered services, the roles of choice counseling, and Medicaid contact center operational procedures.
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.
This position is not a remote or telework position.
Benefits of Working for the State of Florida:
Working for the State of Florida is more than a paycheck. We offer an excellent array of benefits, including:
- Health insurance (i.e., 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 with the State of Florida
- Ability to earn up to 104 hours of sick leave annually
- Nine paid holidays and 1 personal holiday each year
- Opportunities for career advancement
- Tuition waivers (accepted by major Florida Colleges/universities)
- Student loan forgiveness opportunities (eligibility required)
- Training opportunities
- Flexible Spending Accounts
- Shared Savings Program for select medical services
- Lower copays for prescription drugs
- Health and Wellness discounts
For a more complete list of benefits, please visit https://www.mybenefits.myflorida.com/
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 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-F-S, etc.). Knowledge of, or ability to learn, Contact Center policies and procedures, including Choice Counseling.
Knowledge of, or ability to learn, several computer-based systems and programs such as HT, FMMIS, Genesys, Outlook, Excel, Word, SharePoint, People First, etc.
Basic knowledge of medical terminology.
Knowledge of correct spelling, grammar, and punctuation.
Excellent communication skills, both verbal and in writing, including skills listening, understanding, and explaining complex, technical, or confidential information.
Efficient time management, organizational, and multi-tasking skills. Professional interpersonal skills in both one-on-one and in group settings.
Professional telephony skills in a high call volume setting.
Proficient computer typing and/or keyboarding skills. Analytical and problem-solving skills.
Abilities to meet deadlines and to work well under pressure.
Ability to handle sensitive information and adhere to confidentiality requirements.
Ability to follow instructions.
Ability to learn and to apply knowledge.
Ability to adapt to changes.
Ability to maintain professional and effective working relationships.
Ability to 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.
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 experience in a Medicaid call center or high-volume setting.
Bilingual (English/ Spanish) language skills preferred.
LICENSURE, CERTIFICATION, OR REGISTRATION REQUIREMENTS
N/A
CONTACT: TIFFANY TRINIDAD 305-593-3019
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.
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. All documentation is due by the close of the vacancy announcement.
Location:
DORAL, FL, US, 33166
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Nearest Major Market: Miami
