The MO Medicaid Audit & Compliance Unit (MMAC) has an opening for a Registered Nurse within the Missouri Medicaid Audit and Compliance Unit located in Cole County. 

Job Posting Number: 4016 8421006

Semi-monthly salary: $2,786.77

Annual salary: $66,882.40

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: This position will work with the MO HealthNet clinical programs, providing specialized clinical nursing expertise in the performance of audits. Join our team of dedicated professionals working to protect the integrity of the Missouri State Medicaid Program by detecting and preventing fraud, waste and abuse, and recovering improperly expended Medicaid Funds, while ensuring high quality care for Missouri citizens.

Responsibilities - What you’ll do

What you’ll do:    

• Conduct comprehensive desk and on-site audits for post-payment review of MO HealthNet claims ensuring providers are                  appropriately billing and providing services in accordance with federal and state regulations as well as MO HealthNet requirements.
• Develop and maintain a working knowledge and understanding of MO HealthNet policies and procedures, laws, regulations and provide accurate interpretation as needed for the assigned clinical programs. 
• Manage a case load that consists of running reports 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.
• Utilize clinical knowledge and experience to analyze claims for suspicious patterns and unauthorized utilization ensuring billing    compliance.
• Determine whether program providers have followed proper procedures to support the payment of services and evaluate assigned    program policy; making suggestions for MO HealthNet policy change related to findings.
• Utilize knowledge acquired through assigned program requirements, policies, and research to provide clinical assistance. Communicate effectively with other state agencies, providers, and coworkers regarding program requirements related to the reviewing of clinical programs. 
• Monitor corrective action plans, recovery of identified overpayments and provide assistance to unit supervisor or other designated  management or executive staff.
• 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.
• May require the coordination and review of special projects, the development and management of tracking files, and coordinating efforts  between other MO HealthNet units or other agencies.
• Present provider education at the MO HealthNet workshops for the assigned clinical program(s) on behalf of MMAC.
• Some travel is required but will vary based on caseload.

Qualifications - All you need for success

Minimum Qualifications:

Licensure as a Registered Nurse and 0-3 years of experience as a registered nurse. (A recent graduate of an accredited nursing program may practice as a graduate nurse until results of first licensure examination are received or until 90 days after graduation, whichever occurs first.)

Preferred Qualifications:

The position requires knowledge of MO HealthNet programs, the claims payment system, and the ability to read medical records and apply medical knowledge in review of records. Due to the nature of responsibilities associated with this position, good verbal and written communication skills are required for reviews, discussions with both internal and external stakeholders and participation in meetings. This position may need to confer with medical consultants and other MO HealthNet and MMAC employees to provide instructions, obtain advice, coordinate policies and procedures, and resolve common problems to the MO HealthNet program. An ability to deal with various audiences in a professional and courteous manner, at all levels, is required. Ability to work with independence and initiative.

Lack of post‐secondary education will not be used as the sole basis denying consideration to any applicant.

Job Details - More reasons to love this position

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.