Maine Department of Health and Human Services Direct Hire Vacancy Announcement Comprehensive Health Planner I Office of MaineCare Services - Provider Relations Unit

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CODE:  5050	 RANGE  23 (Prof. & Tech. Svcs.)	$35,859.20 - $48,526.40/yr.



Value of State-paid Health & Dental Insurance:  $341.08 biweekly (90% State contribution)



Value of State share of employee retirement:  11.54% of pay.

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Opening Date: October 10, 2012	Contact:	S.Smith
Closing Date: October 26, 2012	Telephone:	(207) 287-1877
Restrictions: Only employees with Promotional Status within the Department of Health and Human Services May Apply
Location: Augusta, ME

Agency Information

The Department of Health and Human Services (DHHS) provides supportive, preventive, protective, public health and intervention services that protect the public health and assist our customers in meeting their needs; and assist families in providing for the developmental, health and safety needs of their children. DHHS strives to provide these programs and services while respecting the rights and preferences of individuals and families. The Office of MaineCare Services (OMS) within DHHS administers and coordinates several major health care financing programs for Maine's citizens. These programs include MaineCare and Maine Rx Plus. OMS assures that the health care programs and services it administers operate in keeping with the Department goals and federal mandates and are consistent with State policy. OMS also provides oversight necessary to ensure accountability and efficient and effective administration. The OMS Provider Relations Unit provides ongoing customer support to MaineCare providers. This position is located in Augusta.

Job Duties

As a Comprehensive Health Planner I in the Provider Relations Unit you will work to support all critical access, non-critical access, and mental health hospitals and their physician practices in Maine. As our hospitals grow and branch out into other aspects of medical care by owning practices and consolidating health care systems, the infrastructure for these entities has become increasingly complex creating additional demand for provider support with MaineCare billing practices, issue resolution, contractual obligations and MaineCare policy interpretation. Hospitals are among the providers significantly impacted by the Medicaid Management Information System (MMIS) implementation of Maine Integrated Health Management Solution (MIHMS), which has resulted in system-related issues impacting timely and accurate claims processing. MIHMS is currently being enhanced to accommodate claims processing for unique situations such as spend down, hospital secondary billing, and DRG/APC pricing and it is critical to have input from the hospitals as these system enhancements are developed. Your duties will include acting as a MaineCare business analyst to ensure hospital needs are considered when enhancements are made. You will work with hospitals to assess their needs, providing appropriate support through telephone contact, conference calls and in person meetings. You will also develop and deliver presentations as a representative of MaineCare to the Maine Hospital Association (MHA), American Association of Healthcare Administration Management-Maine Chapter ( AAHAM), Healthcare Financial Management Association (HFMA), State Uniform Billing Committee (SUBC) as required, and attend these forums as a participant. You will review claims data to answer questions and address hospital's outstanding accounts receivables concerns. You will engage in discussions with hospital CFOs, Directors and Managers to provide updates or answer their questions. Your work will require strong organizational skills and the ability to concisely document and recall specific information which may be needed at a future date when hospitals present issues regarding past events.

Requirements

In order to qualify, you must have a Bachelors Degree from an accredited educational institution in Public/Community Health, Health Administration, Public Administration, Social Work, or a closely related field and three (3) years of progressively responsible experience in the planning, development, and coordination of health programs or services. Directly related experience may be substituted for education on a year-for-year basis. The backgrounds of well-qualified candidates should demonstrate the following competencies:

1. An in-depth knowledge of hospital or other large group healthcare provider administrative structures, internal operations and internal/external billing processes and mechanisms.

2. A demonstrated ability to resolve issues and concerns impacting MaineCare members by working collaboratively with providers, Molina, and other State of Maine agencies.

3. An in-depth knowledge of Medicaid policies, programs, guidelines, procedures, and processes or similar knowledge in a commercial health plan environment.

4. A demonstrated ability to identify, research, and analyze statistical data regarding healthcare services and utilize this data to identify trends and evaluate MaineCare program performance.

5. Strong technical writing skills, including the ability to develop management informational reports summarizing program evaluation data and documenting program performance. (Please provide a technical writing sample.)

6. Exceptional interpersonal communication skills including the ability to lead and facilitate public meetings involving government officials, providers and stakeholder groups.