State of Missouri · 16 hours ago
Benefit Program Senior Specialist
Jefferson City, MO
Full-time
Onsite
Mid, Senior Level
$48K/yr - $48K/yr
1+ years expThe State of Missouri is seeking a Benefit Program Senior Specialist within the Provider Review & Lock-In Unit. This role is responsible for monitoring MO HealthNet program compliance by providers and participants through various review processes and ensuring adherence to federal and state regulations.
AgricultureGovernmentInformation Technology
Responsibilities
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
Willingness to research policies and procedures to make determinations on what enforcement activities to pursue, such as, education, demand of repayment and/or prepayment review from information obtained
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 the 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
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)
Qualification
Required
Bachelor's degree and 1-3 years of relevant experience. (Substitutions may be allowed.)
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
Willingness to research policies and procedures to make determinations on what enforcement activities to pursue, such as, education, demand of repayment and/or prepayment review from information obtained
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 the 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
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)
Preferred
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. General supervision is received from unit supervisor, management, and executive staff
Benefits
Defined pension plan
Generous amounts of leave and holiday time
Eligibility for health insurance coverage
Company
State of Missouri
The State of Missouri is a group of outstanding people that accomplish extraordinary things for our folks every day.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Kevin Mccarthy
Chief Technology Officer
Jennifer Tidball
Chief Operating Officer at Missouri Department of Social Services
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