Benefit Program Senior Specialist 5.14.25

Job Description:

Benefit Program Senior Specialist 5.14.25

Description

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

Job Posting Number : 4016 8260108

Semi-monthly salary: $2,020.69

Annual salary: $48,496.65

Job Location: This position is located at the Knipp Building; 3418 Knipp Drive, 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 Health and Senior Service 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.
• Develop and maintain knowledge and understanding of MO HealthNet policies and procedures for the assigned programs related to Department of Health and Senior Service providers.
• Manage a case load that consist of analyzing and selecting claim samples, review 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, suspension, or termination from program.
• Be 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 review of Department of Health and Senior Service providers.
• Monitor corrective action plans, recovery of identified overpayments and provide assistance to Unit Supervisors, 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 units or agencies.
• You may be required to present at MO HealthNet workshops or Semi Annual MMAC Provider Update meetings regarding your MMAC program.
• Desk and onsite (requires travel) audits.
• The individual in this position must be prepared to use their own professional judgment.

Minimum Qualifications:

Bachelor’s degree and 1-3 years of relevant experience. (Substitutions may be allowed.)

Preferred Qualifications:

• Ability to work independently or in a team structure
• Demonstrate organizational skills, multitask while also prioritizing tasks
• Experience with Project Management tools, i.e. SharePoint and Project Schedule
• Demonstrate and initiate problem solving
• Ability to communicate with stakeholders, contract vendors, and providers
• Great written and verbal communication skills
• Attention to details
• Analyze date and comprehend the results

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 .

If you have questions about this position please contact: Tamara Wills at Tamara.M.Wills@dss.mo.gov .

If you experience accessibility issues while applying, please contact Courtney Hall at Courtney.A.Hall@dss.mo.gov .

Salary:

$48,496.65 per Year