Requisition No: 236641
Agency: Agency for Persons with Disabilities
Working Title: OPERATIONS REVIEW SPECIALIST – 67014991
Position Number: 67014991
Salary: $40,948.18 – $54,879.24 Annually
Posting Closing Date: 09/20/2020
OPERATIONS REVIEW SPECIALIST– CS
AGENCY FOR PERSONS WITH DISABILITIES
STATE OFFICE – 67014991 – TALLAHASSEE, FLORIDA
*** INTERNAL AGENCY- ONLY CURRENT APD EMPLOYEES WILL BE ELIGIBLE***
THIS IS A CAREER SERVICE POSITION
The Agency for Persons with Disabilities works in partnership with local communities to support people with developmental disabilities in living, learning, and working in their communities. APD provides critical services and supports for customers with developmental disabilities to reach their full potential. The Agency serves people with spina bifida, autism, Down syndrome, children age 3-5 at high risk of developmental disabilities, cerebral palsy, Prader-Willi syndrome, Phelan-McDermid syndrome, and intellectual disabilities. There is no charge or co-payment for services provided through the Agency.
DIRECT DEPOSIT PROGRAM – As a condition of employment, a person appointed to a position in State government is required to participate in the Direct Deposit Program. Rather than receiving a paper paycheck, your funds will be deposited directly into your account at your financial institution. This will be accomplished by Electronic Funds Transfer. Banks, savings and loan associations, and credit unions are eligible to accept such deposits. Retirement funds are also required to be in the Direct Deposit Program.
BACKGROUND SCREENING REQUIREMENT:
It is the policy of the Florida Agency for Persons with Disabilities that applicants for employment undergo Level 2 employment screening in accordance with the requirements of Chapter 435, Florida Statutes, as a condition of employment or being permitted to serve as a volunteer.
No applicant for a designated position will be employed or permitted to volunteer until the Level 2 screening results are received, reviewed, and approved by the Agency.
Level 2 background screening shall include, but not be limited to, fingerprinting for Statewide criminal and juvenile records checks through the Florida Department of Law Enforcement, and Federal criminal records checks through the Federal Bureau of Investigation, and may include local criminal records checks through local law enforcement agencies.
THIS POSITION REQUIRES A BACKGROUND INVESTIGATION INCLUDING FINGERPRINTING, PURSUANT TO S. 110.1127(1), FLORIDA STATUTES.
WE HIRE ONLY U.S. CITIZENS AND THOSE LAWFULLY AUTHORIZED TO WORK IN THE U.S. APD PARTICIPATES IN THE U.S. GOVERNMENT’S EMPLOYMENT ELIGIBILITY VERIFICATION PROGRAM (E-VERIFY). E-VERIFY IS A PROGRAM THAT ELECTRONICALLY CONFIRMS AN EMPLOYEE’S ELIGIBILITY TO WORK IN THE UNITED STATES AFTER COMPLETION OF THE EMPLOYMENT ELIGIBILITY VERIFICATION FORM (I-9).
ALL APPLICANTS SHOULD COMPLETE THE ON-LINE APPLICATION PROCESS. IF ASSISTANCE IS NEEDED TO APPLY FOR THIS POSITION, PLEASE CALL THE PEOPLE FIRST SERVICE CENTER AT 1-877-562-7287. RESPONSES TO THE QUALIFYING QUESTIONS ARE REQUIRED TO BE CONSIDERED FOR THIS POSITION. ANSWERS TO THE QUALIFYING QUESTIONS MUST BE VERIFIABLE BASED ON YOUR SUBMITTED APPLICATION.
Internal Agency opportunity- Must be an Agency for Persons with Disabilities (APD) employee.
Must have a high school diploma.
Position may require some travel to surrounding areas, applicant must be willing and able to travel for work purposes.
**NOTE: Applicants must complete all fields in the Candidate Profile. Work history with month, year, and hours worked are required to qualify for this position. Responses to Qualifying Questions must be verifiable in the Candidate Profile. Resumes and other documentation can be attached to provide additional information. ***
Employees of the Agency for Persons with Disabilities are required to demonstrate total commitment to outstanding customer service. This includes, but not limited to, acting in a responsive, professional, courteous manner with the employees, customers and public we serve at all times.
This a professional position who specializes in monitoring and reconciling the CDC+ Program revenue and recommending solutions on financial sand management issues within the CDC+ program. This position involves the independent application of accounting and auditing concepts, principles, theory, and technical skills in accordance with generally accepted accounting principles (GAAP). This position is responsible for reconciling the Agency requests for and receipt of Medicaid funds for the individual consumer's accounts for the CDC+ Program. This position is responsible for identifying and tracking all required Medicaid adjustments to the individual consumer accounts and to work with Program and Area Office staff, as necessary. This position is responsible to monitor and accurately report consumer balances.
This position performs the overall CDC+ program financial analysis in conjunction with Programs and Revenue staff. This position writes policies and procedures related to the financial aspect of the CDC+ program, including federal compliance.
Employee will be responsible to prepare and provide analysis of a variety of programmatic and fiscal monitoring reports to include, but not be limited to, 837/835 claims, duplicate billing of Medicaid funds, consumer balances, and reinvestments.
This position is responsible for reconciling the Agency financial account with the contracted subagent's bank account, and the CDC+ program to the individual consumer's accounts. This is a complicated reconciliation as the program currently has over 3,500 consumers and the potential to add more.
Employee will develop and maintain necessary reconciling forms, processes guidelines, and operational procedures to reconcile the files sent and received for all Medicaid funds (including all paid, suspended, or denied claims).
Employee will identify and track all Medicaid adjustments to the individual consumer accounts. Will work with Program and Area Office, as necessary. Employee will monitor activities on consumer statements looking for discrepancies. Will work with contract subagent to resolve any discrepancies. Will notify management as required.
Advises management on issues with AHCA's fiscal intermediary, the contractor subagent, program policies/processes related to CDC+ program and submits resolution if applicable to ensure the financial integrity of the Program. Designs and Implements modifications when necessary to achieve financial objectives with contracted provider and Agency IT.
Employee will compile and prepare the comprehensive report of consumer monthly balances to include all pending adjustments. This report will be used by various APO staff including management.
Prepare correspondence to consumer/representatives of any adjustments processed against the consumers accounts via email and/ or letters.
Prepare correspondence to consumer, representatives, and consultants of CDC+ Participants ineligibility for Medicaid services via email and/or letters.
Provide management with statistical analyses of the number of claims processed and the total of Medicaid and state funds received on a quarterly basis to be reported on the CDC+ 1915J State plan required report.
Provide management with critical analyses of the data team entries of new providers, new W4 and W9 providers information to be reported on the CDC+ 1915j State plan required report.
Plans and coordinates a response system/process to CDC+ consumers regarding financial issues.
Assists program staff in writing CDC+ financial policies to satisfy federal rules and regulations. Consults with program staff and other financial staff to determine problem areas.
The employee will work CDC finance staff, AHCA and contracted sub-agent (check-writing vendor) on identifying and returning, reinvestment/recoupment of funds for active and disenrolled consumers.
The employee must be productive under tight timeframes, balance multiple and competing priorities and maintain goal-directed behavior and performance sometimes under stressful conditions.
The employee's performance and behavior must demonstrate consideration of the workload concerns of others and must not negatively affect productivity and morale of the unit.
Employee is responsible for creating and distributing monthly budgets for existing consumers when necessary.
Employee is responsible and will safely retain all CDC+ consumer PHI information according to Agency guidelines.
Performs other related activities as assigned.
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.
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. 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 by clicking here. All documentation is due by the close of the vacancy announcement.