Program Integrity Analyst I: Healthcare Fraud & Compliance

State-of-Maine; Augusta (ME); On-site; USD 52,000 - 72,000; Full time

Benefits offered by this job

Health Insurance Coverage

Retirement Plan

Gym Membership Reimbursement

Parental leave

Public Service Student Loan Forgivenes

Job summary

State of Maine seeks a Comprehensive Health Planner I to lead studies identifying fraud, abuse, and waste in the MaineCare program using data analytics. You will review large claims datasets, flag unusual patterns, and follow up with investigations and provider compliance checks.

The role requires strong written communication, knowledge of billing/coding, and proficiency with MS Excel, Word, Access, and SharePoint. Location: Augusta, Maine; salary and benefits reflect state government standards.

Qualifications

• Bachelor’s degree and two years of experience in planning, development, coordination and/or evaluation of health programs or services, or a six-year equivalent.
• Ability to identify, research and analyze a broad range of documents and data related to healthcare services and/or eligibility to verify compliance or identify potential fraud.
• Knowledge of nationally accepted billing forms and coding.
• Exceptional written communication to develop reports summarizing compliance/non-compliance.
• Experience with medical terminology, Excel or similar spreadsheets, Word, Access and SharePoint.

Responsibilities

• Direct and conduct studies to identify fraud, abuse and waste in MaineCare using data analytics and other programs.
• Analyze large volumes of claims data to identify unusual billing patterns and high-cost providers for follow-up.
• Review allegations of fraud and abuse and conduct routine provider reviews for MaineCare compliance.
• Determine non-compliance areas and calculate overpayments; prepare detailed case findings.
• Draft recoupment or sanction letters when appropriate and assist in investigations with other units.

Skills

Data analysis

Billing/coding knowledge

Written communication

Medical terminology

Excel

Word processing

Access database

SharePoint

Education

Bachelor’s Degree in Public/Community Health or related field

Tools

SharePoint

Job description

State of Maine seeks a Comprehensive Health Planner I to lead studies identifying fraud, abuse, and waste in the MaineCare program using data analytics. You will review large claims datasets, flag unusual patterns, and follow up with investigations and provider compliance checks.

The role requires strong written communication, knowledge of billing/coding, and proficiency with MS Excel, Word, Access, and SharePoint. Location: Augusta, Maine; salary and benefits reflect state government standards.