Program Integrity Analyst I

MaineGuide; Augusta (ME); Presencial; USD 52.000 - 72.000; Jornada completa

Descripción de la vacante

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.

Formación

• 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

Responsabilidades

• 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

Educación

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

Descripción del empleo

Department ofHealth and Human Services (DHHS)

Comprehensive Health Planner I

Opening Date:October 28, 2026

Closing Date:November 10, 2026

Job Class Code:5049

Grade:23 (Pro. & Tech. Services)

Salary:$51,500.80 – $72,259.20 per year

Position Number:02000-3381

Location:Augusta

Core Responsibilities:

As a Comprehensive Health Planner I in the Program Integrity Unit, you will direct and conduct studies to identify and verify areas of fraud, abuse and waste in the MaineCare Program by using a data analytics review system among other programs. You will analyze large volumes of claims data to identify unusual or suspicious billing patterns, outliers, high volume or cost providers that may require additional follow-up. You will review/investigate allegations of fraud and abuse and conduct routine reviews of providers to verify compliance with MaineCare rules and regulations. You will determine areas of non-compliance and calculate overpayment amounts. You will prepare detailed spreadsheets of case review findings and when appropriate draft recoupment/sanction letters. You will assist the Healthcare Crimes Unit, OIG and the U.S. Attorney’s Office in case investigations when MaineCare policy and procedure expertise is required and/or when additional administrative review is needed.

Minimum Qualifications:

A Bachelor’s Degree in Public/Community Health, Health Administration, Health Sciences or Health Education; Public Administration, Government, Social Work ,or a closely related field and two (2) years professional experience in the planning, development, coordination and/or evaluation of health programs or services -OR- an equivalent six (6) year combination of education, training, and experience.

The background of well-qualified candidates will demonstrate the following competencies:

• 1.A demonstrated ability to identify, research and analyze a broad range of documents and data related to healthcare services and/or eligibility in order to verify compliance and/or identify