Program Specialist 3

Summary

Pennsylvania Senior Medicare Patrol Program Specialist 3This contracted position is responsible for delivering Senior Medicare Patrol (SMP) Services providing group education and one-on-one assistance to Medicare beneficiaries, their families, and caregivers about how to prevent, detect, and report Medicare fraud, errors, and abuse. This position is responsible for collecting and analyzing information to evaluate program administration and to determine compliance with federal, state, and departmental regulations and objectives; researching, analyzing, and reviewing data to develop and recommend policies and procedures; developing reports on program effectiveness; resolving beneficiary complaints and conducting outreach; assisting in program planning, reporting, and compliance efforts; and recruiting, training, and managing volunteers within their assigned region. The incumbent plays an important role by focusing on community outreach and Medicare beneficiary empowerment with the goal of stopping fraud before it occurs. The incumbent consults with the other Regional Program Specialists and the SMP Project Manager housed in PDA's Education and Outreach Office.Minimum Qualifications Required:Minimum of two (2) years of professional experience in human services providing human services-related research, outreach, or social services to clients, and a bachelor's degree in communications, social work, public health, or a related field. Equivalent experience and training may be considered.Preferred:Prior experience working within a statewide human services program as a social worker, outreach specialist, or program specialist.Knowledge of volunteer recruitment, onboarding, and management practices.Knowledge of the goals, objectives, principles, and practices of human services administration and program operations.Success managing multiple priorities through organization and communication.Duties Administrative:Research and analyze program data, issues, and trends to develop recommendations for program improvements.Evaluate regulations, policies, and procedures to ensure conformance with department objectives.Recommend legislative, regulatory, and policy changes to enhance SMP services.Record and enter into SMP's database outreach, interaction, and complex case data following standardized reporting formats.Successfully complete SMP foundations training and SMP group outreach training.Successfully complete SMP complex interactions training and SMP counselor training.Successfully complete required ACL annual privacy and confidentiality training.Other duties as assigned.Complex Case Work:Provide one-on-one beneficiary support and resolve beneficiary inquiries for complex cases of healthcare billing errors, fraud, and abuse in all statewide regions.Research and interpret Medicare rules and guidelines, applying knowledge as needed to coordinate with external parties and to resolve complex cases.Facilitate referrals to federal and state agencies and law enforcement when appropriate.Help individuals and their loved ones understand how to review their healthcare statements and bills for accuracy and how to identify and avoid potential fraud schemes.Volunteer Management:Recruit, train, and retain a sufficient, effective, and representative volunteer workforce.Utilize Administration for Community Living's (ACL) Volunteer Risk and Program Management (VRPM) in volunteer recruitment, onboarding, and management efforts.Assist volunteers with securing appropriate outreach opportunities to ensure the SMP message is reaching communities throughout the region.Assist in planning and implementing volunteer learning opportunities and training.Outreach and Partnerships:Assist with determining state outreach plans, materials, and campaigns, and assist with the development of reporting requirements.Foster cooperative relationships with statewide organizations to raise SMP awareness.Identify and conduct events to educate the public on healthcare fraud, abuse, and errors.Visit Area Agencies on Aging (AAAs) to provide technical assistance and consultation.Provides consultation and develops recommendations concerning aging services proposals from agencies, colleges, universities, and other sources.Essential Functions:Oversee volunteer recruitment, onboarding, and management within identified region.Conduct complex casework in all statewide regions.Utilize a variety of computer software programs, including PDA's standardized documentation system (Microsoft Office Suite) with a secure internet connection.Demonstrate excellent verbal and written communication skills.Accurately and timely record information and meet all legal and statutory timeframes.Travel within identified region, approximately 50% of business hours.This full-time position is located in the Southwestern Pennsylvania region (Mifflin, Juniata, Perry, Cumberland, Adams, Franklin, Fulton, Huntingdon, Bedford, Blair, Cambria, Somerset, Fayette, Westmoreland, Indiana, Armstrong, Allegheny, Beaver, Washington, and Greene). The incumbent will work from home or be traveling in the field depending on weekly activities. Outreach and education activities are conducted both virtually and in-person.

Job Description

Pennsylvania Senior Medicare Patrol Program Specialist 3This contracted position is responsible for delivering Senior Medicare Patrol (SMP) Services providing group education and one-on-one assistance to Medicare beneficiaries, their families, and caregivers about how to prevent, detect, and report Medicare fraud, errors, and abuse. This position is responsible for collecting and analyzing information to evaluate program administration and to determine compliance with federal, state, and departmental regulations and objectives; researching, analyzing, and reviewing data to develop and recommend policies and procedures; developing reports on program effectiveness; resolving beneficiary complaints and conducting outreach; assisting in program planning, reporting, and compliance efforts; and recruiting, training, and managing volunteers within their assigned region. The incumbent plays an important role by focusing on community outreach and Medicare beneficiary empowerment with the goal of stopping fraud before it occurs. The incumbent consults with the other Regional Program Specialists and the SMP Project Manager housed in PDA's Education and Outreach Office.Minimum Qualifications Required:Minimum of two (2) years of professional experience in human services providing human services-related research, outreach, or social services to clients, and a bachelor's degree in communications, social work, public health, or a related field. Equivalent experience and training may be considered.Preferred:Prior experience working within a statewide human services program as a social worker, outreach specialist, or program specialist.Knowledge of volunteer recruitment, onboarding, and management practices.Knowledge of the goals, objectives, principles, and practices of human services administration and program operations.Success managing multiple priorities through organization and communication.Duties Administrative:Research and analyze program data, issues, and trends to develop recommendations for program improvements.Evaluate regulations, policies, and procedures to ensure conformance with department objectives.Recommend legislative, regulatory, and policy changes to enhance SMP services.Record and enter into SMP's database outreach, interaction, and complex case data following standardized reporting formats.Successfully complete SMP foundations training and SMP group outreach training.Successfully complete SMP complex interactions training and SMP counselor training.Successfully complete required ACL annual privacy and confidentiality training.Other duties as assigned.Complex Case Work:Provide one-on-one beneficiary support and resolve beneficiary inquiries for complex cases of healthcare billing errors, fraud, and abuse in all statewide regions.Research and interpret Medicare rules and guidelines, applying knowledge as needed to coordinate with external parties and to resolve complex cases.Facilitate referrals to federal and state agencies and law enforcement when appropriate.Help individuals and their loved ones understand how to review their healthcare statements and bills for accuracy and how to identify and avoid potential fraud schemes.Volunteer Management:Recruit, train, and retain a sufficient, effective, and representative volunteer workforce.Utilize Administration for Community Living's (ACL) Volunteer Risk and Program Management (VRPM) in volunteer recruitment, onboarding, and management efforts.Assist volunteers with securing appropriate outreach opportunities to ensure the SMP message is reaching communities throughout the region.Assist in planning and implementing volunteer learning opportunities and training.Outreach and Partnerships:Assist with determining state outreach plans, materials, and campaigns, and assist with the development of reporting requirements.Foster cooperative relationships with statewide organizations to raise SMP awareness.Identify and conduct events to educate the public on healthcare fraud, abuse, and errors.Visit Area Agencies on Aging (AAAs) to provide technical assistance and consultation.Provides consultation and develops recommendations concerning aging services proposals from agencies, colleges, universities, and other sources.Essential Functions:Oversee volunteer recruitment, onboarding, and management within identified region.Conduct complex casework in all statewide regions.Utilize a variety of computer software programs, including PDA's standardized documentation system (Microsoft Office Suite) with a secure internet connection.Demonstrate excellent verbal and written communication skills.Accurately and timely record information and meet all legal and statutory timeframes.Travel within identified region, approximately 50% of business hours.This full-time position is located in the Southwestern Pennsylvania region (Mifflin, Juniata, Perry, Cumberland, Adams, Franklin, Fulton, Huntingdon, Bedford, Blair, Cambria, Somerset, Fayette, Westmoreland, Indiana, Armstrong, Allegheny, Beaver, Washington, and Greene). The incumbent will work from home or be traveling in the field depending on weekly activities. Outreach and education activities are conducted both virtually and in-person.