MaineCare Reimbursement Specialist

State of Maine • Augusta, ME

1d • Hybrid

About The Position

As a reimbursement Specialist for PHIP (Private Health Insurance Premium) you will manage a portfolio of cases, determine whether or not the applicant is eligible for the program insurance cost reimbursement. 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. Work with MaineCare Members to answer questions and assist in completing the PHIP Application. Review enrolment applications to ensure accuracy, and all required information is provided. Determine Eligibility, date eligible adding all information into the system module process manager. Track all open PHIP cases quarterly and ensure requirements continue to be met. Verifying mailing address at that time to avoid any delay of timely payments. Complete yearly re-enrollment’s maintaining and assigned Alpha Split. Provider management with reports and data necessary to the program evaluation. Assist with cross-training additional staff Work with a team to ensure a balance in work assignment. Abide by all MaineCare policies, procedures, and regulations regarding Private Healthcare Information. (PHI). The ability to work independently or with a team. This position report’s to the Assistant Division Director of Medicaid and Medicare Services. This is a full-time position located at 109 Capitol Street, Augusta, Maine.

Requirements

• A bachelor’s degree in accounting, Business Administration, or related field and one (1) year experience in health care insurance or related insurance field.
• Directly related work experience may be substituted for education requirements on a year-for-year basis.

Nice To Haves

• 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
• Knowledge of MaineCare or other health care insurance benefits, medical procedure codes, medical terminology and experience
• Demonstrated skills in using Microsoft Word, Excel, and database systems (such as ACCESS), including for report generation and analysis.
• Experience interpreting rules, regulations, and policies.
• Experience using claims-based applications, including research claims history.
• Excellent oral and written communication skills and customer service skills, including the ability to explain complex information to external audiences.

Responsibilities

• Work with MaineCare Members to answer questions and assist in completing the PHIP Application.
• Review enrolment applications to ensure accuracy, and all required information is provided.
• Determine Eligibility, date eligible adding all information into the system module process manager.
• Track all open PHIP cases quarterly and ensure requirements continue to be met.
• Verifying mailing address at that time to avoid any delay of timely payments.
• Complete yearly re-enrollment’s maintaining and assigned Alpha Split.
• Provider management with reports and data necessary to the program evaluation.
• Assist with cross-training additional staff Work with a team to ensure a balance in work assignment.
• Abide by all MaineCare policies, procedures, and regulations regarding Private Healthcare Information. (PHI).
• The ability to work independently or with a team.

Benefits

• 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%-100% of employee-only premiums ($12,845.82 - $15,112.76 annual value), depending on salary.
• Health Insurance Premium Credit – Participation decreases employee-only premiums by 5%.
• Dental Insurance – The State of Maine pays 100% of employee-only dental premiums ($395.72 annual value).
• Retirement Plan – The State contributes the equivalent of 14.11% 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 non-birthing and adoptive parents—receive six weeks of fully paid parental leave.
• Additional, unpaid leave may also be available, under the Family and Medical Leave Act.
• State employees are eligible for an extensive and highly competitive benefits package, covering many aspects of wellness.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Number of Employees: 5,001-10,000 employees