Medical Support Specialist- Claims Position Available In Kennebec, Maine

Medical Support Specialist- Claims Augusta, Maine | Community & Social Services | Full-time Apply by: May 5, 2025 Apply with Linkedin Apply Department of Health and Human Services (DHHS)

Opening Date:

April 22, 2025

Closing Date:

May 5, 2025

Job Class Code:

6574

Grade:

16 (Administrative Services)

Salary:

$18.76 – $27.03 per hour

Position Number:

02031-2353

Location:

Augusta Core Responsibilities:

As a Medical Support Specialist, you will work with a team that reviews claims and claims data from the MaineCare claims processing system and the accuracy of the work of the Claims Division staff. You will use a variety of standard desktop reporting tools such as Microsoft Word, Outlook and Excel to compile, test and report review results.

Desired skills include:

1. Prior experience working with an enterprise-level database. 2. Skilled in using Microsoft Outlook, Word and Excel. 3. The ability to work with a small team to meet targets and improve systems. 4. The ability to work independently. 5. Background in insurance claim processing. 6. Knowledge of (HIPAA) Health Insurance Portability and Accountability Act. 7. A basic knowledge of HCPC, CPT and ICD-9 guidelines. 8. Prior experience performing accounts payable functions. 9. The ability to analyze complex medical claims for adjusted payments

Minimum Qualifications:

Training, education, or experience in office and administrative support work that demonstrates competency in applying a proficient knowledge of medical terminology and medical support functions to perform advanced work in adjusting medical claims errors for adjudication and 2) the ability to use independent judgment, initiative, and discretion to make determinations on varied matters. The background of well-qualified candidates will include the following competencies: (1) The ability to review medical claims for payment, adjudication or adjustments for accuracy and conformance with established policies and practice. (2) Skilled in the use of MIHMS or a comparable automated medical claims system. (3) The ability to compile program data and produce automated management information reports summarizing program performance.

Agency information:

The Department of Health and Human Services (DHHS) provides supportive, preventive, protective, public health and intervention services that safeguard the public health and assist families and individuals to meet their needs. DHHS strives to provide these programs and services while respecting the rights and preferences of individuals and families. The Office of MaineCare Services (OMS) within DHHS administers the state’s Medicaid program and coordinates several major healthcare financing programs for Maine, including the Children’s Health Insurance Program (CHIP). OMS works collaboratively with the Commissioner’s Office of DHHS and the Office of the Governor on health reform and coordinates with other health plans on statewide healthcare improvement initiatives. OMS ensures that the healthcare programs and services it administers operate in alignment with DHHS goals and federal mandates and are consistent with State policy. OMS also provides oversight necessary to ensure accountability and efficient and effective administration. The Claims Adjustment Division oversees the re-processing of claims for MaineCare members that may need to be adjusted or reprocessed including enforcing claims policies and rules and resolving problematic claims. Thinking about applying? Research shows that people from historically excluded communities tend to apply to jobs only when they check every box in the posting. If you’re currently reading this and hesitating to apply for that reason, we encourage you to go for it! Let us know how your lived experience and passion set you apart.

Application Information:

Please submit all documents or files in PDF format. For additional information about this position please contact Crystal Breton, Supervisor Claims Adjustment Unit at (207) 624-4023 or by e-mail at Crystal.

Breton@Maine.gov To apply online, please select the “Apply for this opening” button, upload a resume and cover letter addressing the competency areas listed above. To request a paper application, please contact Mandy Hernandez at Mandy.

Hernandez@Maine.gov 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 years of service, and overtime-exempt employees receive personal leave. + Health Insurance Coverage – The State of Maine pays 85%-95% of employee-only premiums ($11,196.96 – $12,514.32 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. + Dental Insurance – The State of Maine pays 100% of employee-only dental premiums ($387.92 annual value). + Retirement Plan – The State contributes the equivalent of 13.29% of the employee’s pay towards the Maine Public Employees Retirement System (MainePERS). + Parental leave is one of the most important benefits for any working parent. All employees who are welcoming a child—including fathers and adoptive parents—receivesix weeks of fully paid parental leave. Additional, unpaid leave may also be available, under the Family and Medical Leave Act (https://www.maine.gov/bhr/state-employees/workplace-posters) . State employees are eligible for an extensive and highly competitive benefits package (https://www.maine.gov/bhr/state-jobs/compensation-benefits) , covering many aspects of wellness. Learn about additional wellness benefits for State employees from the Office of Employee Health and Wellness (https://www.maine.gov/bhr/oeh/) .

Note:

Benefits may vary somewhat according to specific collective bargaining agreements and are prorated for anything less than full-time. There’s a job and then there’s purposeful, transformative work. Our aim is to create a workplace where you can learn, grow, and continuously refine your skills. Applicants demonstrate job requirements in differing ways, and we appreciate that many skills and backgrounds can make people successful in this role. 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. If you’re looking for a great next step, and want to feel good about what you do, we’d love to hear from you. Please note reasonable accommodations are provided to qualified individuals with disabilities upon request.