Program Integrity Analyst I - Health Compliance Analytics

Department of Marine Resources; Augusta (ME); On-site; USD 52,000 - 72,000; Full time

Job summary

Department of Health and Human Services in Augusta seeks a Comprehensive Health Planner I to lead data-driven reviews identifying fraud, abuse and waste in MaineCare. You will analyze large claims datasets, verify compliance, and draft recoupment or sanction letters as appropriate.

Responsibilities include coordinating with Healthcare Crimes Unit and other authorities, and preparing detailed reports to support investigations and program improvement efforts.

Qualifications

• Bachelor's degree with 2 years health program planning/coordination experience.
• Or an equivalent six-year education/experience combination.

Responsibilities

• Direct and conduct studies to identify fraud, abuse, and waste in MaineCare.
• Analyze large claims data to find unusual or suspicious patterns.
• Investigate allegations and review providers for compliance with MaineCare rules.
• Prepare detailed case findings and assist in recoupment letters when needed.

Skills

Data analysis

Written communication

Billing forms

Billing codes

Excel

Word processing

Access

SharePoint

Education

Bachelor's degree in Public/Community Health or related field

Tools

Excel

Word

Access

SharePoint

Job description

Department of Health and Human Services in Augusta seeks a Comprehensive Health Planner I to lead data-driven reviews identifying fraud, abuse and waste in MaineCare. You will analyze large claims datasets, verify compliance, and draft recoupment or sanction letters as appropriate.

Responsibilities include coordinating with Healthcare Crimes Unit and other authorities, and preparing detailed reports to support investigations and program improvement efforts.