Medical Support Specialist- Claims

Department ofHealth 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: 0

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 enterpriselevel 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 ICD9 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 wellqualified 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 states Medicaid program and coordinates several major healthcare financing programs for Maine including the Childrens Health Insurance Program (CHIP). OMS works collaboratively with the Commissioners 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 reprocessing of claims for MaineCare members that may need to be adjusted or reprocessed including enforcing claims policies and rules and resolving problematic claims.

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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 ator by email at

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

Benefits of working for the State of Maine:

No matter where you work across Maine state government you find employees who embody our state mottoDirigo or I leadas they provide essential services to Mainers every day. We believe in supporting our workforces health and wellbeing with a valuable total compensation package including:

• WorkLife 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 overtimeexempt employees receive personal leave.
• Health Insurance Coverage The State of Maine pays 8595 of employeeonly premiums $11196.96 $12514.32 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 employeeonly dental premiums $387.92 annual value).
• Retirement Plan The State contributes the equivalent of 13.29 of the employees 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 childincluding fathers and adoptive parentsreceive six weeks of fully paid parental leave. Additional unpaid leave may also be available under the Family and Medical Leave Act.

State employees are eligible for anextensive and highly competitive benefits package covering many aspects of wellness. Learn about additional wellness benefits for State employees from the Office of Employee Health and Wellness.

Note: Benefits may vary somewhat according to specific collective bargaining agreements and are prorated foranything less than fulltime.

Theres a job and then theres 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 youre looking for a great next step and want to feel good about what you do wed love to hear from you. Please note reasonable accommodations are provided to qualified individuals with disabilities upon request.