Provider Relations Payment Error Rate Specialist (PERM)

maine; Augusta (ME); On-site; USD 29,000 - 40,000; Full time

Job summary

Department of Health and Human Services (DHHS) in Augusta, Maine seeks a Provider Relations Specialist to train providers on the PERM process and to ensure compliant billing and documentation under MaineCare guidelines.

The role focuses on minimizing Medicaid program penalties through education, outreach, and accurate claims analysis, while coordinating with internal and external partners.

Qualifications

• A four (4) year combination of training and experience providing a knowledge of health care administration and community health services.

Responsibilities

• Develop and deliver training to reduce provider billing and documentation errors in PERM.
• Interpret MaineCare policies and provide guidance to providers for PERM audits.
• Collaborate with OMS, DHHS and external partners to resolve complex claims issues.

Job description

Department of Health and Human Services (DHHS)

Provider Relations Specialist

Opening Date: August 21, 2026

Closing Date: September 3, 2026

Job Class Code: 5011

Grade: 20 (Professional & Technical)

Salary: $20.68 - $28.88 per hour

Position Number: 20002-5207

Location: Augusta

Currently, this position is not eligible for visa sponsorship or STEM OPT extensions.

Core Responsibilities:

This position reports to the Provider Services Manager and position will focus on a targeted approach to providing the necessary training and education to reduce provider error rates relating to billing and documentation in compliance with H.R.1, Section 71106, for the Payment Error Rate Measurement (PERM) process and ultimately reducing and mitigating any State Medicaid risks of imposed penalties. The position will also support the PERM Difference Resolution Process, which is the formal mechanism under the Payment Error Rate Measurement (PERM) program that allows states to challenge or clarify findings made by federal review contractors in Medicaid and CHIP audits.

Training will be conducted in person, virtually, and through Statewide forums with a targeted focus on various examples of PERM errors and those providers may experience. Strengthening these processes is critical to prevent future error rates from surpassing the 3% limit and protecting the state from potential penalties.

The position will also require a working knowledge of MaineCare member eligibility requirements and classifications to support accurate and effective claims analysis. The individual must be able to manage multiple and evolving priorities in an organized and efficient manner while maintaining composure, professionalism, and sound judgment when addressing challenging situations.

This position will conduct outreach to providers to support the Medicaid Program Integrity Audit by sending communications to request documentation, maintain detailed record of outreaches and discussions, and analyze results of the documentation received.

Regular duties include:

• Utilizing strong verbal and written communication skills to develop and present provider training and educational materials on the PERM process. Training may be for individual providers or for groups, both on-site and virtually.
• Interpreting and applying MaineCare policies, with a primary focus on the MaineCare Benefits Manual, and providing clear, accurate, and timely guidance to MaineCare providers to support the PERM audit process. This includes communicating policy requirements, clarifying applicable guidance, and assisting providers in understanding their responsibilities and compliance obligations. The position will ensure that provider communications are consistent with established MaineCare policies and procedures and are presented in a clear and professional manner.
• Collaborating effectively with internal teams across the Office of MaineCare Services (OMS) and the Department of Health and Human Services (DHHS), as well as external vendor partners, to research, analyze, and resolve complex claims issues. This includes working closely with teams responsible for claims processing, policy development and interpretation, utilization management, rate setting, and prior authorization to identify root causes, clarify requirements, and develop appropriate and timely resolutions. The position will also participate in cross-functional workgroups and project teams supporting large-scale initiatives, system changes, policy implementations, and other organizational priorities as needed.
• Representing OMS and the Department by participating in provider forums, stakeholder groups, provider association meetings, and other external meetings to both share policy and billing information and to gather information about policy or billing issues.

Minimum Qualifications:

A four (4) year combination of training and experience providing a knowledge of health care administration and community health services.

Preferred experience includes:

• Experience with and knowledge of the Medicaid program and/or other health and human services programs serving low-income populations
• Lived experience with Medicaid and/or other health-related social needs common to individuals and families receiving Medicaid coverage

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

1. 1. A proven ability to investigate and resolve complex medical insurance claims billing issues, and a thorough knowledge of MaineCare provider policies, programs, guidelines, procedures, and processes or similar knowledge in a commercial health plan environment
2. 2. A demonstrated ability to de