Human Services Program Specialist
About the position The Department of Human Services is seeking a Human Services Program Specialist who is ready to take on challenging and important work. In this role, you will review information, analyze data, and help identify fraud, waste, and abuse within key programs. Your work will support fair practices and promote confidence in public services. Bring your skills to a position where accuracy and integrity truly matter. This position supports the Bureau of Program Integrity by reviewing referrals, analyzing data, and helping identify fraud, waste, and abuse within the Medical Assistance Program.
Responsibilities
- Review referrals, analyze claim and encounter data, and identify discrepancies in provider records
- Organize assigned cases by planning review activities and ensuring work is completed on schedule
- Assess the type and amount of authorized services and confirm that documentation supports billing
- Develop case findings, consult with medical staff, and prepare letters and recommendations
- Prepare materials for internal and external stakeholders, including fraud control partners
- Maintain tracking information and manage paper and electronic case files in accordance with policy
Requirements
- One year of professional experience developing, implementing, or evaluating human services, social services, health care services, or health care insurance programs.
- You must meet the PA residency requirement.
- You must be able to perform essential job functions.
Benefits
- Free parking
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