68900227 - OPS SR HUMAN SERVICE PROGRAM SPEC

Requisition No: 854573 

Agency: Agency for Health Care Administration

Working Title: 68900227 - OPS SR HUMAN SERVICE PROGRAM SPEC

 Pay Plan: Temp

Position Number: 68900227 

Salary:  $17.53 - $19.00 Hourly 

Posting Closing Date: 06/19/2025 

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 - $19.00 per hour, 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.

 

Join our dynamic and innovative team as an OPS Senior Human Services Program Specialist!

In this role, you'll have the opportunity to make a real impact by assisting with investigative activities, utilizing cutting-edge resources to conduct investigations, and collaborating with a passionate team on exciting projects.

You'll play a key role in preparing referrals to law enforcement and analyzing trends to help prevent fraud and abuse in the Florida Medicaid program

 

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 incl