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State of Missouri · 2 days ago

Benefit Program Senior Specialist

Jefferson City, MO

Full-time

Onsite

Mid, Senior Level

$48K/yr - $48K/yr

1+ years exp

The State of Missouri is seeking a Benefit Program Senior Specialist for the MO Medicaid Audit & Compliance Unit within the Provider Review Unit. This role is responsible for monitoring compliance for programs administered by the Department of Mental Health, conducting post-payment reviews of MO HealthNet claims, and managing a case load of claim samples and medical record documentation.

AgricultureGovernmentInformation Technology

Responsibilities

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

Become well-informed regarding the understanding of MO HealthNet programs, policies, and procedures for the assigned programs related to Department of Mental Health providers

Manage a case load that consists of analyzing and 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 MO HealthNet 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

General computer knowledge and be proficient in Word and Excel

Requires a significant amount of reading

Qualification

MO HealthNet knowledgeCompliance monitoringData analysisProject Management toolsWritten communicationVerbal communicationOrganizational skillsAttention to detail