Benefit Program Senior Specialist

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.

About the role

This position offers the opportunity to work with a dedicated team committed to protecting the integrity of the Missouri State Medicaid Program. Your work will help detect and prevent fraud, waste, and abuse; identify improperly expended Medicaid funds; and support efforts to ensure high-quality care for Missouri citizens.

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.
• Review and understand MO HealthNet policies and procedures in assigned programs related to Department of Mental Health programs.
• Initiate research on policies and procedures to determine enforcement actions, such as education, demand of repayment, and prepayment review based on information gathered.
• Become well-informed and knowledgeable about the review process and findings to provide effective testimony at an Administrative Hearing Commission.
• Manage a case load consisting of analyzing and selecting claim samples, reviewing medical record documentation to support billings, preparing written reports on findings, and determining administrative actions such as education, demand of repayment, and prepayment review.
• 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.
• Coordinate and review special projects, develop and manage tracking files, and coordinate efforts between other MHD units or other agencies.
• Present at MO HealthNet workshops for your program(s) on behalf of MMAC.
• Participate in desk and onsite audits (which may require some travel).

Requirements

• Bachelor’s degree and 1-3 years of relevant experience. Substitutions may be allowed.
• Great written and verbal communication skills.
• Ability to work independently or in a team structure.
• Demonstrate organizational skills, multitask while prioritizing tasks.
• Demonstrate and initiate problem-solving abilities.
• Able to communicate with stakeholders, contract vendors, and providers.
• Attention to details.
• Understand the analysis of data and comprehend the results.
• Dependable.
• Training or education in Leadership (lack of post-secondary education will not be used as the sole basis for denying consideration).

Qualifications

• Minimum qualifications: Bachelor’s degree and 1-3 years of relevant experience.

Skills

• General computer knowledge and proficiency in Word and Excel.

Benefits

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.

Pay

Semi-monthly salary: The current rate for this position is $2,020.69. Annual salary: $48,496.65

Schedule

Individuals selected for this position may receive a higher rate based on a pay differential (e.g., shift, or time-of-service pay).

Location

This position is located at the Knipp Building; 3418 Knipp Drive, Jefferson City, MO.

Application

All internal promotional applicants are encouraged to apply as there may be alternate office space available. The application deadline is July 23, 2026.

Contact Information

If you have questions about this position, please contact: Spenser Epple at Spenser.J.Epple@dss.mo.gov. If you experience accessibility issues while applying, please contact Courtney Hall at Courtney.A.Hall@dss.mo.gov.