State of Maine · 20 hours ago
Program Integrity Analyst I
Augusta, Maine
Full-time
Onsite
Entry Level
$49K/yr - $69K/yr
2+ years expThe Department of Health and Human Services (DHHS) is dedicated to promoting health and safety for Maine residents. The Program Integrity Analyst I will conduct studies to identify fraud, abuse, and waste in the MaineCare Program by analyzing claims data and ensuring compliance with healthcare regulations.
Art
Responsibilities
Direct and conduct studies to identify and verify areas of fraud, abuse and waste in the MaineCare Program
Analyze large volumes of claims data to identify unusual or suspicious billing patterns
Review/investigate allegations of fraud and abuse
Conduct routine reviews of providers to verify compliance with MaineCare rules and regulations
Determine areas of non-compliance and calculate overpayment amounts
Prepare detailed spreadsheets of case review findings
Draft recoupment/sanction letters
Assist the Healthcare Crimes Unit, OIG and the U.S. Attorney’s Office in case investigations when MaineCare policy and procedure expertise is required
Qualification
Required
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 two (2) years professional experience in the planning, development, coordination and/or evaluation of health programs or services -OR- an equivalent six (6) year combination of education, training, and experience
A demonstrated ability to identify, research and analyze a broad range of documents and data related to healthcare services and/or eligibility in order to verify compliance and/or identify potential fraud
Knowledge of and experience with nationally accepted billing forms and coding
Exceptional written communication skills to include the ability to develop written reports that summarize compliance/non-compliance
Knowledge and experience with medical terminology, Excel or comparable spreadsheet applications, MS Word or comparable word process application, Access or comparable database application and SharePoint or comparable file sharing application
Benefits
13 paid holidays
12 days of sick leave
3+ weeks of vacation leave annually
Health Insurance Coverage
Health Insurance Premium Credit
Dental Insurance
Retirement Plan
Six weeks of fully paid parental leave
Company
State of Maine
Welcome! We in Maine take pride in our quality of life, our entrepreneurial spirit, and our strong, independent heritage.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$0.76MKey Investors
The National Endowment for the Arts
2019-05-18Grant· $0.76M
Leadership Team
Carole Reuschle
CEO of the Cabin
Joseph Zamboni
Chief Operating Officer
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