Health Program Auditor & Data Analyst (MaineCare)
maine
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Job summary
Department of Health and Human Services (DHHS) in Augusta, Maine, seeks a Comprehensive Health Planner II to review and implement algorithms measuring MaineCare service utilization and flag potential fraud. The role performs complex audits of MaineCare providers with funds from state and federal sources and maintains federal reporting requirements.
The candidate will analyze MaineCare policies and healthcare records, use spreadsheet and database tools, and contribute to ensuring funds are spent
Qualifications
- Bachelor's degree in Public/Community Health or related field and three years of professional health program experience; or seven years equivalent
- Experience with MaineCare or state/federal funded programs and compliance
- Strong analytical and data interpretation skills in health services settings
Responsibilities
- Review and implement algorithms in computer systems to monitor MaineCare utilization and identify potential fraud
- Conduct independent audits/reviews of MaineCare providers and programs receiving state/federal funds
- Maintain the Division's federal reporting requirements and ensure compliance with laws, rules, and standards
- Analyze MaineCare policies, procedures, claims data, and budget information to support program integrity goals
Skills
Education
Tools
Job description
Department of Health and Human Services (DHHS) in Augusta, Maine, seeks a Comprehensive Health Planner II to review and implement algorithms measuring MaineCare service utilization and flag potential fraud. The role performs complex audits of MaineCare providers with funds from state and federal sources and maintains federal reporting requirements.
The candidate will analyze MaineCare policies and healthcare records, use spreadsheet and database tools, and contribute to ensuring funds are spent
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