MaineCare Reimbursement Specialist Augusta , Maine , United States | Accounting, Business, & Finance | Full-time | Partially remote Apply by: Feb. 28, 2025 Apply with Linkedin Apply Department of Health and Human Services (DHHS)Opening Date:February 14, 2025Closing Date: February 28, 2025Job Class Code:0441 Grade:20 (Professional & Technical Services) Salary:$43,014.40 - $60,070.40 per yearPosition Number:02000-3318Location: Augusta This position reports to the Assistant Division Director of Medicaid and Medicare Services. This is a full-time position located at 109 Capitol Street, Augusta, Maine. This opportunity allows partial telework with management approval. Core Responsibilities: As an Estate Recovery Unit Reimbursement Specialist, you will manage a portfolio of cases, determine the amount of MaineCare recoupment (lien), and provide this information to heirs of an estate, attorneys, courts, and MaineCare members. You will evaluate and interpret State and Federal statute, rules, and laws to comply with required procedures. You will generate reports and process all necessary paperwork to document case files. Attention to detail is a must, as is the ability to handle a large volume of work and to make decisions independently. Additional duties are described below. • Follow Estate Recovery case protocols to determine MaineCare recoupment (lien) amounts. • Review, interpret, and process cases in accordance with desk level procedures and state and federal regulations. • Research and generate reports of medical claims associated with a deceased MaineCare member. • Contact attorneys and personal representatives of estates to discuss amounts due to MaineCare. • Negotiate recovery liens with attorneys, personal representatives and probate court to reclaim as many MaineCare dollars as possible. • Follow up on cases with appropriate interested parties and bring to resolution/closure. • As needed, consult with the Assistant Division Director of Medicaid and Medicare Services and/or Assistant Attorney General to resolve a case or when cases become difficult to resolve without senior management assistance. • Close all cases by reviewing project file and ensuring all necessary forms, notes, and reports are included in the project file. Minimum Qualifications: A Bachelor’s Degree in Accounting, Business Administration or related field and one (1) year of experience in healthcare insurance or a related insurance field. Directly related work experience may be substituted for education requirements on a year-for-year basis. Additional years of equivalent experience may be substituted for education on a year-for-year basis. Preferred experience includes: • Experience with and knowledge of the Medicaid program and/or other health and human services programs serving low-income populations • Lived experience with Medicaid and/or other health-related social needs common to individuals and families receiving Medicaid coverage The backgrounds of the well-qualified candidate will demonstrate the following competencies: 1. Knowledge of MaineCare or other health care insurance benefits, medical procedure codes, and medical terminology and experience 2. Demonstrated skills in using Microsoft Word, Excel, and database systems (such as ACCESS), including for report generation and analysis. 3. Experience interpreting rules, regulations, and policies. 4. Experience using claims-based applications, including to research claims history. 5. Excellent oral and written communication skills and customer service skills, including the ability to explain complex information to external audiences. Thinking about applying? Research shows that people from historically excluded communities tend to apply to jobs only when they check every box in the posting. If you’re currently reading this and hesitating to apply for that reason, we encourage you to go for it! Let us know how your lived experience and passion set you apart. Agency information: TheDepartment of Health and Human Services (https://www.maine.gov/dhhs/) (DHHS) is dedicated to promoting health, safety, resilience, and opportunity for Maine people. The Department provides health and social services to approximately a third of the State's population, including children, families, older Mainers, and individuals with disabilities, mental illness, and substance use disorders. The Department also promotes public health, operates two state psychiatric hospitals, and provides oversight to health care providers. The Office of MaineCare Services (OMS) within DHHS administers the state’s Medicaid program, which provides health insurance coverage for low-income families, adults and children so they can access the important health care services they need to be healthy and be a part of the community through work, caring for family, going to school, and more. OMS works collaboratively within DHHS, with other Departments and the Office of the Governor, with MaineCare members, with providers, and with other health care purchasers on statewide healthcare improvement initiatives. OMS is committed to advancing health equity efforts to improve access to care and health outcomes for all low-income Mainers. OMS provides benefit coverage and supports the services that operate in alignment with Department goals, federal mandates and State policy. OMS also provides oversight necessary to ensure accountability and efficient and effective administration. The Estate Recovery Unit is a part of the Third Party Liability (TPL) team, within the Division of Operations in OMS. The federal government requires that states recoup Medicaid (MaineCare) costs paid on behalf of a member from age 55 until death from that member’s estate. Monies recouped by Estate Recovery and other TPL business units ensure that MaineCare is the payor of last resort. Application Information: Please submit all documents or files in PDF format. To apply, upload a resume and cover letter addressing the three competency areas identified in the Qualifications Section. For additional information about this position please contact Roger Bondeson at (207) 287-2705 or by e-mail Roger.Bondeson@Maine.gov To request a paper application, please contact Mandy.Hernandez@Maine.gov Benefits of working for the State of Maine: No matter where you work across Maine state government, you find employees who embody our state motto—"Dirigo" or "I lead"—as they provide essential services to Mainers every day. We believe in supporting our workforce's health and wellbeing with a valuable total compensation package, including: + Work-Life Fit – Rest is essential. Take time for yourself using 13 paid holidays , 12 days of sick leave , and 3+ weeks of vacation leave annually. Vacation leave accrual increases with years of service, and overtime-exempt employees receive personal leave. + Health Insurance Coverage – The State of Maine pays 85%-95% of employee-only premiums ($11,196.96 - $12,514.32 annual value), depending on salary. Use this chart to find the premium costs for you and your family, including the percentage of dependent coverage paid by the State. + Dental Insurance – The State of Maine pays 100% of employee-only dental premiums ($387.92 annual value). + Retirement Plan – The State contributes the equivalent of 13.29% of the employee's pay towards the Maine Public Employees Retirement System (MainePERS). + Parental leave is one of the most important benefits for any working parent. All employees who are welcoming a child—including fathers and adoptive parents—receivesix weeks of fully paid parental leave. Additional, unpaid leave may also be available, under the Family and Medical Leave Act (https://www.maine.gov/bhr/state-employees/workplace-posters) . State employees are eligible for an extensive and highly competitive benefits package (https://www.maine.gov/bhr/state-jobs/compensation-benefits) , covering many aspects of wellness. Learn about additional wellness benefits for State employees from the Office of Employee Health and Wellness (https://www.maine.gov/bhr/oeh/) . Note: Benefits may vary somewhat according to specific collective bargaining agreements and are prorated for anything less than full-time. There's a job and then there's purposeful, transformative work. Our aim is to create a workplace where you can learn, grow, and continuously refine your skills. Applicants demonstrate job requirements in differing ways, and we appreciate that many skills and backgrounds can make people successful in this role. As an Equal Opportunity employer, Maine State Government embraces a culture of respect and awareness. We are committed to creating a strong sense of belonging for all team members, and our process ensures an inclusive environment to applicants of all backgrounds including diverse race, color, sex, sexual orientation or gender identity, physical or mental disability, religion, age, ancestry, national origin, familial status or genetics. If you’re looking for a great next step, and want to feel good about what you do, we’d love to hear from you. Please note reasonable accommodations are provided to qualified individuals with disabilities upon request.