Maine Department of Health and Human Services Direct Hire Vacancy Announcement Medical Care Coordinator

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CODE: 5055	   RANGE:  16 (Prof & Tech Services B.U.)     	$12.93 - $17.05/hr.



Value of State-paid Health & Dental Insurance:  $341.08



Value of State's share of Employee's Retirement: 11.54% of pay

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Opening Date: October 19, 2012	Contact:	Sarah McGuire
Closing Date: November 2, 2012	Telephone:	(207) 287-1873
Location: Augusta

Agency Information

The Department of Health and Human Services provides supportive, preventive, protective, public health and intervention services that protects the public health and assists our customers in meeting their needs; and that 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 Breast and Cervical Health Program within the Maine Center for Disease Control and Prevention provides breast and cervical cancer screening and diagnostic services to underserved women.

Job Duties

As the Medical Care Coordinator for the Breast and Cervical Health Program you will be responsible for: accurately processing claims for screening services; ensuring correct provider reimbursement; resolving errors and discrepancies; resolving client billing issues; determining payment of Manual Review claims prior to initiating claim resolution; providing assistance to medical providers regarding individual claim submission. You will conduct eligibility and claims research using the state Automated Client Eligibility System (ACES) and Maine Integrated Health Management Solution (MIHMS), as well as MBCHP's Data Management and Reporting System (DMRS). The position coordinates all aspects of provider billing and claims submission, works "pended" MBCHP claims, reviews eligibility when members open MaineCare or Medicare, communicates with providers to resolve billing issues, and collaborates with the MBCHP Case Manager when diagnosis codes on claims indicate abnormal test results not previously reported to MBCHP.

Requirements

A four (4) year combination of education and experience in medical eligibility programs and/or experience which demonstrates interviewing and data gathering skills as needed to form basis for judgments in eligibility determinations, claims resolutions, and payment authorization.



Applicants should have experience with medical/pharmacy claims processing associated with MaineCare. Preference will be given to applicants who can demonstrate a working knowledge of MBCHP eligibility and proficiency with MBCHP DMRS database.