MaineCare Reimbursement Specialist

Location: Augusta,Maine,United States

Department of Health and Human Services (DHHS)

Reimbursement Specialist

Opening Date: March 26, 2025

Closing Date: April 8, 2025

Job Class Code: 0441
Grade: 20 (Professional & Technical Services)
Salary: $43,014.40 - $60,070.40 per year

Position Number: 02000-3318

Location: Augusta

This position reports to the Assistant Division Director of Medicaid and Medicare Services. This is a full-time position located at 109 Capitol Street, Augusta, Maine. This opportunity allows partial telework with management approval.

Core Responsibilities:

As an Estate Recovery Unit Reimbursement Specialist, you will manage a portfolio of cases, determine the amount of MaineCare recoupment (lien), and provide this information to heirs of an estate, attorneys, courts, and MaineCare members. You will evaluate and interpret State and Federal statute, rules, and laws to comply with required procedures. You will generate reports and process all necessary paperwork to document case files. Attention to detail is a must, as is the ability to handle a large volume of work and to make decisions independently. Additional duties are described below.

•    Follow Estate Recovery case protocols to determine MaineCare recoupment (lien) amounts.
•    Review, interpret, and process cases in accordance with desk level procedures and state and federal regulations.
•    Research and generate reports of medical claims associated with a deceased MaineCare member.
•    Contact attorneys and personal representatives of estates to discuss amounts due to MaineCare.  
•    Negotiate recovery liens with attorneys, personal representatives and probate court to reclaim as many MaineCare dollars as possible.
•    Follow up on cases with appropriate interested parties and bring to resolution/closure. 
•    As needed, consult with the Assistant Division Director of Medicaid and Medicare Services and/or Assistant Attorney General to resolve a case or when cases become difficult to resolve without senior management assistance.  
•    Close all cases by reviewing project file and ensuring all necessary forms, notes, and reports are included in the project file.

Minimum Qualifications:

A Bachelor’s Degree in Accounting, Business Administration or related field and one (1) year of experience in healthcare insurance or a related insurance field. Directly related work experience may be substituted for education requirements on a year-for-year basis. Additional years of equivalent experience may be substituted for education on a year-for-year basis.  

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 backgrounds of the well-qualified candidate will demonstrate the following competencies:
1.    Knowledge of MaineCare or other health care insurance benefits, medical procedure codes, and medical terminology and experience 
2.    Demonstrated skills in using Microsoft Word, Excel, and database systems (such as ACCESS), including for report generation and analysis.
3.    Experience interpreting rules, regulations, and policies.
4.    Experience using claims-based applications, including to research claims history.
5.    Excellent oral and written communication skills and customer service skills, including the ability to explain complex information to external audiences.

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Agency information: 

The Department of Health and Human Services (DHHS) is dedicated to promoting health, safety, resilience, and opportunity for Maine people. The Department provides health and social services to approximately a third of the State's population, including children, families, older Mainers, and individuals with disabilities, mental illness, and substance use disorders. The Department also promotes public health, operates two state psychiatric hospitals, and provides oversight to health care providers.

The Office of MaineCare Services (OMS) within DHHS