Comprehensive Health Planner II - Repost

Location: Augusta,Maine,United States

Opening Date: May 29, 2024

Closing Date:  June 12, 2024

Job Class Code: 5050
Grade: 26
Salary: $54,620.80 – $73,756.80 
Position Number: 141000001

JOB DESCRIPTION:

The MHDO is required by Statute to create and maintain a comprehensive health care data base and to make the data available to the broadest extent possible while protecting individual confidentiality. This position is responsible for managing the overall requirements defined in 90-590 chapters 243, 247, 570 and 730, which includes MHDO’s health care data streams for the all-payer claims data, non-claims-based payments and other supplemental health care data, prescription drug pricing component data and cancer registry and vital statistics data. This position will also support the administrative and technical aspects of the rule making process at it relates to these data streams; and prepare the agency’s annual assessment calculations. This position will work closely with MHDO’s executive director and assist with projects as needed, finance director, and data vendor, as well as over 800 individual data submitters, which include health insurance companies, pharmaceutical manufactures, wholesale distributors and pharmacy benefit managers.

REQUIRED KNOWLEDGES:

• Knowledge of health care claims data
• Knowledge of claims file specifications and data standards
• Knowledge of pharmaceutical data and supply chain
• Knowledge of on-line tools and systems
• Ability to understand complex laws, rules, and regulations
• Ability to develop, organize, and complete projects on time
• Ability to work effectively both independently and with other team members
• Ability to manage several projects at once
• Ability to gather, synthesize, and summarize a variety of information from many sources
• Ability to communicate effectively both verbally and in writing

TYPICAL DUTIES:

• Establish and maintain contact with MHDO data submitters for each data stream
• Collaborate with MHDO’s data vendor on data submission compliance issues
• Identify specific data submission issues and work with the appropriate data submitters to address concerns
• Coordinate and participate in educational webinars with data submitters
• Draft and send various written communications to data submitters
• Participate in MHDO’s bi-montly data user group meetings
• Become the subject matter expert in the provisions and requirements in 90-590 Chapters 100, 243, 247, 570 and Chapter 730
• Manage all aspects of compliance with the data submission requirements in 90-590 Chapters 243, 247, 570 and chapter 730
• Collaborate with the executive director and finance director on identifying the entities subject to the annual agency assessment, calculating the individual assessment amounts, preparing and sending invoices, and managing follow up as needed.
• Collaborate with the executive director and team members in preparing the draft documentation required for proposed rule changes including both the administrative and technical expertise needed for Chapters 100, 243, 247, 570, 730, and other agency rules as requested
• Assist the executive director with special projects as requested

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 three (3) years professional experience planning, development, coordination and/or evaluation of health programs or services -OR- an equivalent seven (7) year combination of education, training, and experience.

Preference will be given to those with experience in the health insurance field, pharmaceutical data, health care billing, coding and or medical claims file mapping to national standards, managing complex rules and or interpreting legislation or complex policies, developing and managing relationships with hundreds of different entities.

Benefits of working for the State of Maine:

No matter where you work across Maine state government, you find employees who embody our state motto—"Dirigo" or "I lead"—as they provide essential services to Mainers every day. We believe in supporting our workforce's health and wellbeing with a valuable total compensation package, including:

• Work-Life Fit – Rest is essential. Take time for yourself using 13 paid holidays, 12 days of sick leave, and 3+ weeks of vacation leave annually. Vacation leave accrual increases with year