Maine Department of Health and Human Services Direct Hire Vacancy Announcement MaineCare Quality Assurance Auditor

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CODE:  4102	   RANGE:  20 (Prof Tech Services B.U.)     	$15.05 - $20.28/hr.



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 19, 2012	Contact:	S.Smith
Closing Date: November 5, 2012	Telephone:	(207) 287-1877
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 has primary responsibility for administering the MaineCare Program, including development of coverage policy, provider and member support, provider reimbursement, quality assurance, and pharmacy benefits. OMS assures that the health care programs and services it administers operate in keeping with the Department goals, federal mandates and are consistent with State policy. OMS also provides oversight necessary to ensure accountability and efficient and effective administration. This position is in the MaineCare Quality Assurance Unit within the OMS Operations Division. The position is located in Augusta.

Job Duties

As a MaineCare Quality Assurance Auditor you will be responsible for a variety of tasks including conducting quality reviews, Fiscal Agent audits and claims reviews. You will analyze system reports, review data logs, and consult with State subject matter experts and internal/external on-line resources to determine accuracy and quality of performance on specific requirements. You will assess the financial impact of defects discovered during audits and recommend improvements to operational systems and procedures to ensure compliance and improve effectiveness. You will use your excellent Office PC skills to create and maintain spreadsheets, manuals and other documentation of work processes and findings.

Requirements

In order to qualify, you must have a bachelors degree in business administration, public administration, healthcare management or related field OR a four (4) year combination of education, training and/or experience in medical claims processing, resolution and/or adjudication. Preferred qualifications include a knowledge of State of Maine enterprise level applications (a knowledge of the Medicaid system MIHMS - Maine Integrated Health Management Solution is preferred), standard desktop automation technologies including the Office PC suite and a thorough knowledge of medical terminology. Prior experience conducting compliance audits and on-line research, and demonstrated ability to create and maintain reports and spreadsheets are also preferred.

The background of well qualified candidates will demonstrate the following competencies:

1. A thorough knowledge of MaineCare policy, eligibility, enrollment and service coverage requirements.

2. A demonstrated ability to conduct on-line research including the use of research tools/sites such as State of Maine Internet sites, SharePoint, Google etc.

3. Knowledge of medical procedure codes including CPT, HCPCS, and ICD9.

4. Please rate your skills in each of the following as expert, skilled or novice:
a. Medical terminology: _____
b. Excel or comparable spreadsheet application: _____
c. MS Word or comparable word processing application: _____
d. MIHMS (Maine Integrated Health Management System): _____
e. Other enterprise-level application systems:
(Please list applications and skill level. Example: ACES - expert, MFASIS - novice)