Maine Department of Health and Human Services Direct Hire Vacancy Announcement REIMBURSEMENT SPECIALIST THIRD PARTY LIABILITY DRUG REBATE

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CODE:  0441DH    RANGE: 20 (Pro/Tech Svcs bargaining unit)	$15.05 - $20.28/hr.



Value of State-paid Health & Dental Insurance:  $339.45 biweekly 

(Health: $326.16 biweekly / Dental: $13.29 biweekly).



Value of State’s share of employee’s retirement:  19.96 % of pay.

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Opening Date: October 30, 2009	Contact:	S.Smith
Closing Date: November 13, 2009	Telephone:	(207) 287-1877
Restrictions: Only employees with Promotional Status within the Department of Health and Human Services May Apply
Location: Augusta

Agency Information

The Department of Health and Human Services (DHHS) is driven by its vision of Maine people living safe, healthy and productive lives. Its goal is to assist the people of Maine in meeting their own needs, as well as the developmental, health and safety needs of their children. It serves the public in an environment that reflects a caring, responsive and well-managed organization. The Office of MaineCare Services within DHHS administers and coordinates several major health care financing programs for Maine’s citizens. These programs include MaineCare, Medical Eye Care and Maine Rx Plus. The Office works collaboratively with the Governor's Office of Health Policy and Finance on health reform, and coordinates with other health plans on statewide healthcare improvement initiatives. MaineCare assures that the health care programs and services it administers operate in keeping with the Department’s goals and federal mandates and are consistent with State policy. MaineCare also provides oversight necessary to ensure accountability and efficient and effective administration. The Third Party Liability Division is responsible for enforcing State and Federal Third Party Liability rules designed to ensure MaineCare is the payer of last resort. We have an immediate vacancy in our Drug Rebate Unit in our Augusta office.

Job Duties

As a Reimbursement Specialist in the Drug Rebate Unit, you will be responsible for investigation and recovery of drug rebate payments owed to the State from drug manufacturers and labelers. Responsibilities include submitting drug rebate invoices to participating drug labelers, entering and reconciling rebate payments in the system database, researching and analyzing NDC reports, paid claim information and drug pricing and packaging information whenever a drug manufacturer disputes invoiced amounts, identifying, negotiating and resolving disputed units with drug manufacturers and pharmacies. This position reports to the Drug Rebate Manager and will assist the Manager in achieving unit goals and activities, including the generation and interpretation of various reports required of the unit.

Requirements

In order to qualify, you must have a five-year combination of education, training and experience comprised of a Bachelors Degree and one year of experience in researching and resolving medical claims billing issues or other comparable collection/reimbursement functions. Additional years of equivalent experience may be substituted for education on a year-for-year basis. The backgrounds of well-qualified candidates will demonstrate the following competencies:

1. As a Reimbursement Specialist you will communicate by phone, electronically via e-mail and in writing with prescription drug companies, pharmacy providers, attorneys, physicians and physician offices. To successfully perform these duties, you will need strong oral and written communication skills. Please tell us about those aspects of your background that demonstrate you have the oral and written communication skills to be successful as a Reimbursement Specialist.

2. Reimbursement Specialists investigate and research overpayments to providers as well as potential leads for recovery of MaineCare funds from liable third parties (e.g. private insurance carriers). Tell us about those experiences that demonstrate you can successfully investigate and resolve complex medical and insurance billing issues or provider overpayments.

3. Drug manufacturers frequently challenge the volume and/or the dollar amount of drug rebates owed to the State. As a Reimbursement Specialist, you will negotiate with these drug manufacturers in an effort to resolve the disputed items. Please tell your experiences that demonstrate you are an effective negotiator.