Benefit Program Senior Specialist 11.6.24

The MO Medicaid Audit & Compliance Unit (MMAC) has an opening for a Benefit Program Senior Specialist within the Provider Review Unit located in Cole County.

Job Posting Number: 4016 8260012 11.6.24

Semi-monthly salary: $2,020.69

Annual salary: $48,496.65

Job Location: This position is located at 3418 Knipp Drive, Suite 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 program compliance by Department of Mental Health providers.

• Conduct post-payment review of MO HealthNet claims ensuring providers are appropriately billing and providing services in accordance with federal and state regulations and MO HealthNet requirements.
• Maintain knowledge and understand MO HealthNet policies and procedures for the assigned programs related to the reviewing of Department of Mental Health providers.
• Manage a case load that consists of selecting claim samples, review of medical record documentation to support billings, prepare written reports regarding any findings, and make determinations on what administrative action to pursue, such as, education, demand of repayment and/or prepayment review.
• Become well-informed and knowledgeable regarding the review process and any findings so that an effective testimony can be provided at an Administrative Hearing Commission.
• Communicate effectively with other state agencies, providers, and coworkers regarding program requirements related to the reviewing of Department of Mental Health providers.
• Monitor corrective action plans, recovery of identified overpayments and provide 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.
• Desk and onsite audits (which will require some travel)
• The individual in this position must be prepared to use his/her own professional judgment.

Minimum Qualifications:

Bachelor’s degree and 0-2 years of relevant experience. (Substitutions may be allowed.)

Preferred Qualifications:

• Good written and verbal communication skills.
• Ability to plan, organize and prioritize work.
• Initiative and curiosity to obtain, process and logically apply information.
• Ability to perform independently and in a group setting as needed.

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 .

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• State of Missouri

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