Comprehensive Health Planner II
About The Position
As a Comprehensive Health Planner II, you will review and implement algorithms using computer systems designed for measuring and monitoring utilization of MaineCare covered services and identifying potential areas of fraud and abuse. You will conduct independent and complex compliance and/or programmatic audits/reviews of MaineCare providers and programs that receive state and federal funds from the Department of Health and Human Services. These audits are required to ensure compliance with established laws, rules, regulations and standards. In addition, you will be responsible for maintaining the Division’s required federal reports. To successfully perform these duties, you must have the ability to comprehend and analyze complex MaineCare policies and procedures, the related healthcare claims, medical and clinical healthcare records, and budget and expenditure information. You must be highly skilled with standard desktop technology, particularly spreadsheet and database applications. You must be detail oriented, able to work independently and possess a high level of initiative. As a Comprehensive Health Planner II you will contribute to the Department’s mission and goals by helping to ensure public assistance funds are utilized for the purposes enacted in 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 and possess a high level of initiative.
Responsibilities
- Review and implement algorithms using computer systems designed for measuring and monitoring utilization of MaineCare covered services and identifying 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 from the Department of Health and Human Services.
- 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.
- Contribute to the Department’s mission and goals by helping to ensure public assistance funds are utilized for the purposes enacted in legislation.
Benefits
- 13 paid holidays
- 3+ weeks of vacation leave annually
- Personal leave for overtime-exempt employees
- 12 days of sick leave per year
- Health Insurance Coverage (State pays 85%-95% of employee-only premiums)
- Health Insurance Premium Credit (decreases employee-only premiums by 5%)
- Dental Insurance (State pays 100% of employee-only dental premiums)
- Retirement Plan (State contributes 14.06% to 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
