Job Location: This position is located at the 3418 Knipp Dr, Ste. F, Jefferson City, MO.
The
Department of Social Services partners with families and communities to protect children, rehabilitate youth and move families to self-sufficiency so that Missourians can lead safe, healthy and productive lives.
Why you’ll love this position: The person in this position will work with a dedicated team of employees while gaining new and valuable skills. This is an independent position responsible for monitoring MO HealthNet program compliance by MO HealthNet providers and participants.
- Conduct post-payment review of MO HealthNet claims ensuring providers are making appropriate payments, billing and providing services according to federal and state regulations and MO HealthNet requirements.
- Review and understand MO HealthNet policies and procedures in assigned programs related to Behavioral Health and Applied Behavior Analysis (ABA) Programs.
- Make determinations on what enforcement activities to pursue, such as, education, demand of repayment and/or prepayment review.
- Selection of claim samples, review of medical record documentation, evaluation of findings, and preparation of written reports.
- Explain the review process and results, and testify to the Administrative Hearings Commission, as required.
- Monitor corrective action plans, recovery of identified overpayments and providing assistance to Unit Supervisor or other designated management or executive staff.
- May require the coordination and review of special projects, the development and management of tracking files, and coordinating efforts between other MHD units or other agencies. You may also be required to present at the MO HealthNet workshops for your program(s) on behalf of MMAC.
- This position may need to confer with medical consultants and other MMAC and MO HealthNet Division employees to provide instruction, obtain advice, coordinate policies and procedures, and resolve common problems to the MO HealthNet program. The ability to deal with various audiences in a professional and courteous manner, at all levels, is required.
- The individual in this position must be prepared to use his/her own professional judgment.
- You may also be required to present at the MO HealthNet workshops for your program(s) on behalf of MMAC.
- Desk and onsite audits (which will require some travel around the State) .
Minimum Qualifications
Bachelor’s degree and 1-3 years of relevant experience. (Substitutions may be allowed.)
Preferred Qualifications - Good communication skills, professionalism, accuracy, priorities and tact.
- Good verbal and written communication skills for reviews, discussions with providers, other State agencies and MMAC Investigation Unit, and participation in meetings.
- Work is performed with independence and initiative.
Lack of post-secondary education will not be used as the sole basis denying consideration to any applicant.The State of Missouri offers an excellent benefits package that includes a defined pension plan, generous amounts of leave and holiday time, and eligibility for health insurance coverage. Your total compensation is more than the dollars you receive in your paycheck. To help demonstrate the value of working for the State of Missouri, we have created an interactive Total Compensation Calculator. This tool provides a comprehensive view of benefits and more that are offered to prospective employees. The Total Compensation Calculator and other applicant resources can be found here .
