Comprehensive Health Planner II
About The Position
The Department of Health and Human Services (DHHS) is seeking a Comprehensive Health Planner II to review and implement algorithms for measuring and monitoring MaineCare services utilization and identifying potential fraud and abuse. This role involves conducting independent and complex compliance and/or programmatic audits/reviews of MaineCare providers and programs that receive state and federal funds. The position is responsible for ensuring compliance with established laws, rules, regulations, and standards, and for maintaining the Division’s required federal reports. The ideal candidate will have the ability to comprehend and analyze complex MaineCare policies, healthcare claims, medical records, and budget information, and must be highly skilled with standard desktop technology, particularly spreadsheet and database applications. This role requires attention to detail, the ability to work independently, and a high level of initiative, contributing to the Department’s mission of ensuring public assistance funds are utilized as intended by legislation.
Requirements
- A Bachelor’s Degree in Public/Community Health, Health Administration, Health Sciences or Health Education; Public Administration, Government, Social Work, or a closely related field and three (3) years professional experience in the planning, development, coordination and/or evaluation of health programs or services -OR- an equivalent seven (7) year combination of education, training, and experience.
- Knowledge/experience in healthcare and claims research analysis.
- Knowledge/experience using spreadsheet and database applications.
- Knowledge/experience in auditing/reviewing healthcare related services.
- Knowledge/experience in utilizing nationally accepted billing forms and coding.
- Highly skilled with standard desktop technology, particularly spreadsheet and database applications.
- Detail oriented.
- Able to work independently.
- Possess a high level of initiative.
Responsibilities
- Review and implement algorithms using computer systems designed for measuring and monitoring utilization of MaineCare covered services.
- Identify potential areas of fraud and abuse.
- Conduct independent and complex compliance and/or programmatic audits/reviews of MaineCare providers and programs that receive state and federal funds.
- Ensure compliance with established laws, rules, regulations, and standards.
- Maintain the Division’s required federal reports.
- Comprehend and analyze complex MaineCare policies and procedures, related healthcare claims, medical and clinical healthcare records, and budget and expenditure information.
Benefits
- 13 paid holidays
- 3+ weeks of vacation leave annually
- 12 days of sick leave per year
- Health Insurance Coverage (State pays 85%-95% of employee-only premiums)
- Health Insurance Premium Credit (Participation decreases employee-only premiums by 5%)
- Dental Insurance (State pays 100% of employee-only dental premiums)
- Retirement Plan (Maine Public Employees Retirement System - MainePERS)
- Gym Membership Reimbursement (up to $40 per month)
- Health and Dependent Care Flexible Spending Accounts
- Public Service Student Loan Forgiveness eligibility
- Living Resources Program (employee assistance program)
- Six weeks of fully paid parental leave
- Voluntary Deferred Compensation (MaineSaves 457(b) account)
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
