Health Program Auditor & Data Analyst

MaineGuide; Augusta, Northern (ME, KY); Hybrid; USD 56,000 - 79,000; Full time

Job summary

The Department of Health and Human Services (DHHS) in Maine seeks a Comprehensive Health Planner II to assess MaineCare utilization, detect fraud, and ensure program compliance. You will conduct complex audits, review healthcare records and budgets, and prepare federal reports, leveraging strong data analysis and database skills.

This position requires a relevant bachelor’s degree, three years of professional health program experience (or a seven-year equivalent), and is located in Augusta.

Qualifications

• Bachelor's degree and three years of health program experience or seven years of equivalent work history.
• Experience with MaineCare policies, claims analysis, and budget/expenditure data.
• Familiarity with nationally accepted billing forms and coding.

Responsibilities

• Review and implement algorithms to measure MaineCare utilization and detect fraud.
• Conduct independent audits of MaineCare providers and programs receiving state/federal funds.
• Maintain federal reports and analyze complex policies, medical records, and expenditures.
• Utilize spreadsheets and databases with a high level of detail and initiative.

Skills

Healthcare claims analysis

Spreadsheet & database tools

Healthcare auditing

Billing & coding knowledge

Education

Bachelor's Degree in Public/Community Health, Health Administration, Health Sciences or Health Education; Public Administration, Government, Social Work, or related field

Job description

The Department of Health and Human Services (DHHS) in Maine seeks a Comprehensive Health Planner II to assess MaineCare utilization, detect fraud, and ensure program compliance. You will conduct complex audits, review healthcare records and budgets, and prepare federal reports, leveraging strong data analysis and database skills.

This position requires a relevant bachelor’s degree, three years of professional health program experience (or a seven-year equivalent), and is located in Augusta.