Provider Relations Specialist

Department of Health and Human Services; Augusta (ME); On-site; USD 43,000 - 60,000; Full time

Benefits offered by this job

Health Insurance

Vacation leave

Parental leave

Retirement plan

Job summary

Department of Health and Human Services in Augusta, ME, is seeking a qualified professional to interpret MaineCare policies, analyze complex claims data, and collaborate with internal teams and external partners to resolve issues. The role involves developing provider trainings and assisting in enrollment determinations based on MaineCare guidelines.

The position emphasizes communicating policy requirements clearly, presenting training materials, and contributing to large-scale program

Qualifications

• Four-year combination of training and experience in health care administration.
• Knowledge of MaineCare policies strongly preferred.
• Experience with Medicaid programs preferred.
• Strong communication and training skills.

Responsibilities

• Interpret MaineCare policies and provide guidance to providers.
• Research complex claims data and assist providers with resolution.
• Collaborate with internal teams and external partners on claims issues.
• Develop and present provider training on MaineCare policy and claims.
• Assist with enrollment determinations for provider types.
• Participate in provider forums and stakeholder meetings.

Skills

Claims analysis

Adult training

Excel

Collaboration

Independent work

Tools

PowerPoint

Job description

Department of Health and Human Services (DHHS) 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: 02000-2530 Location: Augusta Currently, this position is not eligible for visa sponsorship or STEM OPT extensions.

Core Responsibilities

• Interpreting and applying MaineCare policies, with a primary focus on the MaineCare Benefits Manual, and providing clear, accurate, and timely guidance to MaineCare providers. 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.
• Researching complex claims data by exporting claims data onto spreadsheets, analyzing claims data, assessing root cause and remediation, and assisting providers with resolution.
• 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.
• Utilizing strong verbal and written communication skills to develop and present provider training and educational materials on MaineCare policy and claims and billing. Training may be for individual providers or for groups, both on-site and virtually.
• Assisting providers to determine the appropriate provider type and specialty under which to enroll with MaineCare, as determined by the services the provider renders.
• 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

• 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

Competencies

• 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. A demonstrated ability to develop and deliver adult training programs to diverse audiences, including comfort with Microsoft PowerPoint
• 3. Strong analytical and problem-solving skills, including comfort with Microsoft Excel
• 4. Ability to foster collaborative working relationships with both internal and external stakeholders
• 5. Ability to work independently on multiple projects while maintaining progress on daily work.

Benefits of working for the State of Maine

• Work-Life Fit – Rest is essential. Take time for yourself using 13 paid holidays and 3+ weeks of vacation leave annually. Vacation leave accrual increases with years of service, and overtime-exempt employees receive personal leave. When you or immediate members of your family are ill, utilize 12 days of sick leave per year.
• Health Insurance Coverage – The State of Maine pays 85%-95% of employee-only premiums ($12,213.60 - $13,650.48 annual value), depending on salary. Use this chart to find the premium costs for you and your family, including the percentage of dependent coverage paid by the State.
• Health Insurance Premium Credit – Participation decreases employee-only premiums by 5%. Visit the Office of Employee Health and Wellness for more information about program requirements.
• Dental Insurance – The State of Maine pays 100% of employee-only dental premiums ($365.28 annual value).
• Retirement Plan – The State contributes the equivalent of 14.06% of the employee's pay towards the Maine Public Employees Retirement System (MainePERS), on behalf of the employee.
• Gym Membership Reimbursement – Improve overall health with regular exercise and receive up to $40 per month to offset this expense.
• Health and Dependent Care Flexible Spending Accounts – Set aside money pre-tax to help pay for out-of-pocket health care expenses and/or daycare expenses.
• Public Service Student Loan Forgiveness – The State of Maine is a qualified employer for this federal program. For more information, visit the Federal Student Aid office.
• Living Resources Program – Navigate challenging work and life situations with our employee assistance program.
• Parental leave is one of the most important benefits for any working parent. All employees who are welcoming a child—including non-birthing and adoptive parents—receive six weeks of fully paid parental leave. Additional, unpaid leave may also be available, under the Family and Medical Leave Act.
• Voluntary Deferred Compensation – Save additional pre-tax funds for retirement in a MaineSaves 457(b) account through payroll deductions.
• State employees are eligible for an extensive and highly competitive benefits package, covering many aspects of wellness.

Equal Opportunity Employer Statement

As an Equal Opportunity employer, Maine State Government embraces a culture of respect and awareness. We are committed to creating a strong sense of belonging for all team members, and our process ensures an inclusive environment to applicants of all backgrounds including diverse race, color, sex, sexual orientation or gender identity, physical or mental disability, religion, age, ancestry, national origin, familial status or genetics.

Please note reasonable accommodations are provided to qualified individuals with disabilities upon request.

For additional information about this position please contact Heidi Brann, at [phone].

To request a paper application, please contact [e-mail].