Requisition No: 850782
Agency: Department of Health
Working Title: OPERATIONS & MGMT CONSULTANT II - SES - 64084119
Pay Plan: SES
Position Number: 64084119
Salary: $43,000 to $44,200
Posting Closing Date: 04/28/2025
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Internal Agency Opportunity
Applicants accepted only from Department of Health employees, (includes OPS, Career Service, SES or SMS employees). Applicants will not be accepted from outside of the department.
PLEASE NOTE: Completion of candidate work history on the State of Florida Employment Application is required in order to be considered. Submission of a resume cannot be accepted in lieu of the completed work history but can be included with your application.
THIS IS AN ANTICIPATED VACANCY.
Your Specific Responsibilities:
This position spends the majority of the time engaged in supervisory responsibilities. This includes communicating with, motivating, training, and evaluating employees in addition to planning and directing employees' work. The incumbent has the authority to hire, transfer, suspend, lay off, recall, promote, discharge, assign, reward, or discipline subordinate employees or effectively recommend such action. The incumbent will also be required to develop performance expectations, meet with staff regularly to discuss performance, complete performance reviews, maintain vacation and work schedules, ensuring proper coverage, and complete timesheets.
This position performs a variety of complex operations and management support functions which require substantial technical, financial, administrative and operational knowledge of accounting practices. It also requires a thorough understanding of medical and insurance claim procedures. The duties of this position will be dedicated to maximizing local accounts receivables thru third party payers (Medicaid, Medicare, Private Insurance Companies, Organizations, etc.) for personal medical and dental services provided by qualified staff of the Florida Department of Health (FDOH) and assists management in the utilization of the Health Management System (HMS) currently in use by the FDOH. The incumbent in this position is responsible for the integrity and confidentiality of data sets under his/her control.
Oversees and participates in the processing of the daily operations of a Medical billing department ensuring accuracy and compliance with healthcare regulations, internal FDOH policies and procedures and confidentiality guidelines are met.
Processes third party reimbursement claims for personal healthcare and dental services provided by the FDOH Duval County (FDOHDC) and other counties serviced by the Bay County Billing Hub which includes verifying client’s Medicaid, Medicaid Managed Care, Medicare, or any other Third Party Liability coverage, verifying client’s medical services are correctly coded (both CPT and ICD 10), correcting and rebilling any errors discovered, and verifying that correct billing practices are followed.
Ensures all third-party payments are accurately posted to the applicable client’s account within the HMS and denied claims are to be researched and resubmitted within 30 days of the date denial is received per FDOH Accounts Receivable Policy (DOH-56-66-17). Works independently to solve billing problems by evaluating and researching using available tools and information to determine resolution of the claim to include crossover claims, corrected claims, appealed claims, AHCA complaints, etc. Must remain up to date with all local policies and procedures as they pertain to billing as this position will advise staff as needed on FDOH billing procedures.
Assists in the credentialing process for the FDOHDC as a group and for all healthcare and dental providers for third party payers (Medicaid, Medicare, Insurance Companies who require or offer better reimbursement rates for providers who are credentialed).
Develops and maintains current standards for submitting, receiving and following up of denied claims from all third-party reimbursement sources. The standards will provide guidelines for healthcare and dental providers to ensure accuracy and validity of claims submitted for reimbursement. Responsible for evaluating and monitoring all third-party claims submitted by FDOHDC for reimbursement by the above referenced standards beginning monthly with corrective action plan for non-compliant claims.
Assist in the training and support for staff required to use various websites to perform functions of their positions which may include the following web portals: Availity, Change Health, Medicaid, Payspan, Dentaquest. Liberty, Capital Health, etc.
Prepares statistical reports on request from the Financial Administrator: Report will include number of third party reimbursement claims by vendor, amount filed, amount received, number and amount of denied claims by vendor, reasons for denial, number of denied claims resubmitted for payment, number of client write-off accounts and amounts, number of accounts sent to state collection agency. Prepares trend reports as described above beginning July 1 of current fiscal year and concurrently thereafter.
Assists internal clients with HMS billing reports as needed. Audits eligible services monthly to verify that all services eligible to be billed were billed correctly. Assist in the correction and rebilling of any errors discovered and bills client service to Medicaid when clients are assigned to coverage retroactively.
Supervises multiple billing staff employees to provide billing and related services to FDOHDC. Approve timesheets, prepare expectations and evaluations. Provides training and oversight on all billing functions provided by the staff assigned to the FDOHDC.
Provides other related duties as required by this position.
Required Knowledge, Skills, and Abilities:
Qualifications:
Incumbent may be required to work before, during and/or beyond normal work hours or days in the event of an emergency. Emergency duty required of the incumbent includes working in special needs or Red Cross shelters, or performing other emergency duties including, but not limited to, responses to or threats involving any disaster or threat of disaster, man-made or natural.
Florida Department of Health Mission, Vision, and Values:
Mission:
To protect, promote & improve the health of all people in Florida through integrated state, county & community efforts.
Vision:
To be the Healthiest State in the Nation.
Values:
I nnovation: We search for creative solutions and manage resources wisely.
C ollaboration: We use teamwork to achieve common goals & solve problems.
A ccountability: We perform with integrity & respect.
R esponsiveness: We achieve our mission by serving our customers & engaging our partners.
E xcellence: We promote quality outcomes through learning & continuous performance improvement.
Where You Will Work:
Panama City, Florida
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 set of employee benefits including:
- Annual and Sick Leave benefits;
- Nine paid holidays and one Personal Holiday each year;
- State Group Insurance coverage options, including health, life, dental, vision, and other supplemental insurance options;
- Retirement plan options, including employer contributions
(For more information, please click www.myfrs.com);
- Flexible Spending Accounts;
- Tuition waivers;
- And more!
For a more complete list of benefits, including monthly costs, visit www.mybenefits.myflorida.com.
Please be advised:
Your responses to qualifying questions for this position must be verifiable by documentation provided through the electronic application process.
This position requires a security background check and/or drug screening and participation in direct deposit. Any misrepresentations or omissions will disqualify you from employment consideration. Note: You will be required to provide your Social Security Number (SSN) in order to conduct this background check Successful completion of a drug test is a condition of employment for safety-sensitive positions.
Male applicants born on or after October 1, 1962, will not be eligible for hire or promotion unless they are registered with the Selective Services System (SSS) before their 26th birthday, or have a Letter of Registration Exemption from the SSS. For more information, please visit the SSS website: http://www.sss.gov
If you are a retiree of the Florida Retirement System (FRS), please check with the FRS on how your current benefits will be affected if you are re-employed with the State of Florida. Your current retirement benefits may be canceled, suspended or deemed ineligible depending upon the date of your retirement.
The successful candidate will be required to complete the Form I-9 and that information will be verified using the E-Verify system. E-Verify is operated by the Department of Homeland Security in partnership with the Social Security Administration to verify employment eligibility.
Incumbents may be required to perform emergency duty before, during, and/or beyond normal work hours or days.
All Florida Department of Health positions require the incumbent to be able to learn and communicate effectively, orally and in writing, in English. Applicants who do not meet this requirement will not be considered.
The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer and does not tolerate discrimination or violence in the workplace.
Applicants requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-877-562-7287). 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.
Florida has the third largest population of veterans in the nation with more than 1.5 million service men and women. The Florida Department of Health (department) is committed to serving members of the United States Armed Forces, veterans and their families by encouraging them to apply for vacancies that fit their area of knowledge and/or expertise. Through the Department's VALOR program, which expedites licensing for military veterans, the Department also waives initial licensing and application fees for military veterans who apply for a health care professional license within 60 months of an honorable discharge. These initiatives help ensure that the transition from military service into the workforce is as smooth as possible and reflects our appreciation for the dedication devoted to protecting our country.
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.
