at State of Maine, Bureau of Human Resources in Augusta, Maine, United States
Planning & Research Associate I-Office of MaineCare ServicesAugusta , Maine , United States | Human Services | Full-time Apply by: Aug. 6, 2021 Apply with Linkedin Apply
Department of Health and Human Services (DHHS)Opening Date: July 26, 2021 Closing Date: August 6, 2021 Job Class Code: 0039
Salary: $37,128.00 – $49,857.60/yr.Position Number: 02031-1961
The Department of Health and Human Services (DHHS) is dedicated to promoting health, safety, resilience, and opportunity for Maine people. The Department provides health and social services to approximately a third of the State’s population, including children, families, older Mainers, and individuals with disabilities, mental illness, and substance use disorders. The Department also promotes public health, operates two state psychiatric hospitals, and provides oversight to health care providers.
The Division of Program Integrity is responsible for providing audit oversight services of Community Agencies and MaineCare providers. These services include auditing of programs and services to test for compliance and identification of appropriate or improper payments.
As a Planning and Research Associate I in the Program Integrity Unit, you will assist staff in conducting studies to identify and verify areas of potential fraud, abuse and waste in the MaineCare Program using the Java Surveillance and Utilization Review System (J-SURS) among other programs. You will assist in the analysis of large volumes of MaineCare claims to identify unusual or suspicious patters, outliers, high volume/costs providers that may require additional follow-up. You will support staff in determining areas of noncompliance, calculation of overpayment amount and preparing detailed spreadsheets to support the findings. You will receive and enter community complaints into the electronic tracking database for assignment and follow-up. You will assist the Healthcare Crimes Unit, the OIG and the U.S. Attorney’s Office in case investigations by performing data queries and gathering requested information. As a Planning and Research Associate I, 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.
A six (6) year combination of education, training, and/or experience providing a knowledge of the principles of research and planning.
Preferred candidateswill have:
+ Excellent oral and written communication skills.
+ A demonstrated ability to identify and research a broad range of documents and data related to healthcare services in order to verify compliance and/or identify potential fraud.
+ Computer skills, including experience with Microsoft Word, Excel, and Access.
For additional information about this position, please contact Valerie Hooper, Supervisor, at 287-2414 orValerie.Hooper@maine.gov.To apply, please upload a resume and cover letter addressing the three performance areas in the requirements section on or before the closing date. To request a paper application, please contact Ashley Smith at (207) 287-1895 or by email atAshley.Smith@maine.gov.
Benefits are vital to your health and well-being. We get it. Here’s what the State of Maine offers:
+ growth – build your career
+ health, dental, and vision insurance – take care of yourself
+ retirement savings – financially independent, even after you stop working
+ flexible spending accounts – manage out-of-pocket healthcare and/or daycare costs
+ Living Resources(employee assistance program) – overcome difficult situations with support
+ paid holidays – twelve each year
+ federal public loan forgiveness program- for qualifying loans and payments
+ statewide locations – from Kittery to Madawaska
+ training – develop knowledge, skills, and understanding
The bi-weekly dollar values of some State-paid benefits for full-time employees include: $14.60 for dental insurance; 13.16% of employee’s pay towards retirement; and, depending on the employee’s annual pay, at least 85% ($412.23) of health insurance premiums (more information is available here). Participation in theHealth Premium Credit Programcan decrease the employee’s cost of health insurance by 5%.
The Department of Health and Human Services is an Equal Opportunity/Affirmative Action employer. We provide reasonable accommodations to qualified individuals with disabilities upon request.