Healthcare Compliance & Integrity Analyst I

MaineGuide; Augusta (ME); On-site; USD 52,000 - 72,000; Full time

Job summary

Department of Health and Human Services (DHHS) in Augusta seeks a Comprehensive Health Planner I to direct and conduct studies identifying fraud, abuse, and waste in the MaineCare Program using data analytics and reviews of provider performance.

The role involves analyzing large volumes of claims data to flag unusual patterns, verifying compliance with MaineCare rules, calculating overpayments, and drafting letters for recoupment or sanctions as needed.

Qualifications

• A Bachelor’s Degree in Public/Community Health, Health Administration, Health Sciences or Health Education; Public Administration, Government, Social Work, or closely related field and two (2) years professional experience
• Or an equivalent six (6) year combination of education, training, and experience

Responsibilities

• Direct and conduct studies to identify fraud, abuse and waste in the MaineCare Program using a data analytics review system among other programs
• Review/investigate allegations of fraud and abuse and conduct routine reviews of providers to verify compliance with MaineCare rules and regulations

Education

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

Job description

Department of Health and Human Services (DHHS) in Augusta seeks a Comprehensive Health Planner I to direct and conduct studies identifying fraud, abuse, and waste in the MaineCare Program using data analytics and reviews of provider performance.

The role involves analyzing large volumes of claims data to flag unusual patterns, verifying compliance with MaineCare rules, calculating overpayments, and drafting letters for recoupment or sanctions as needed.