Hospital Reimbursement Specialist position at Maine.| United States Of America

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Maine Hospital Reimbursement Specialist

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Pattern: full-time

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Augusta, Maine....United States Of America

If you are a current State of Maine employee, you must complete your application through the internal application process (Find Jobs Report). Please apply using your PRISM account. If you are on Seasonal Leave and do not have access to PRISM, contact your local Human Resources representative for application information. Department of Health and Human Services (DHHS) Public Service Coordinator II Opening Date: January 22, 2026 Closing Date: February 4,, 2026 Job Class Code: CA29 Grade: 29 (Confidential) Salary: $68,993.59 - $97,635.20 per year Position Number: 02000-4178 Location: Augusta -Limited Period Position- Job Description: This position offers an opportunity to combine analytical skills with public service impact, helping to design and implement equitable, data-driven reimbursement systems that sustain access to high-quality care. As a hospital specialist in Rate Setting you will: • Lead analysis of hospital cost reports, claims, and financial data to shape hospital reimbursement reform and ensure MaineCare’s hospital payment models are sustainable, equitable, and aligned with quality care outcomes. • Support MaineCare’s transition toward more value-driven and transparent hospital payment systems, developing data models and financial tools that link cost, utilization, and outcomes. • Review claims data to understand hospital billing practices and trends and communicate actionable information to senior leadership. • Track federal and state legislation and policy changes impacting hospitals and estimating potential provider impacts and fiscal impacts. • Create and lead presentations, both to internal Department groups and to external providers or partners. • Lead work with program staff from OMS Policy, Delivery System Reform, Provider Relations, Care Coordination, and other OMS units, and also from other DHHS Offices, to develop and implement policies impacting hospitals. • Engage with OMS Program Integrity staff to monitor potential fraud, waste, and abuse in hospital billing and reimbursement. • Evaluate and model the fiscal impacts of proposed reimbursement strategies, providing senior leadership with actionable insights that guide multimillion-dollar hospital payment decisions. • Analyze post-implementation impacts of the adopted changes to reimbursement policies. • Oversee the process of generating supplemental payments to hospitals. • Be a subject matter expert on hospital cost reports and understand financial pressures hospitals are facing. • Create reports or dashboards with important data and key metrics about hospitals. • Troubleshoot and respond to questions and issues that arise related to hospital reimbursement. Minimum Qualifications: To qualify, you must have an eight (8) year combination of education and/or experience comprised of a Master’s Degree in Business Administration, Non-Profit Administration, Finance, Health Care Administration or a closely related field and two (2) years of experience in cost, budget, and financial analysis. Directly related professional 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 background of well-qualified candidates will demonstrate the following competencies: 1. Experience working with hospital cost reports, financial statements, and claims data 2. Strong written and oral communication skills, including the ability to lead meetings and public presentation. 3. Experience using analytics tools with ability to write SQL queries is preferred 4. Ability to research law, regulations, and Medicaid policies to provide sound advice and recommendations to executive managers 5. Ability to synthesize and present complicated analysis and technical information in an understandable and concise manner to support decision-making 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 experience and passion set you apart. 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 administers the state’s Medicaid program, which provides free or low-cost health insurance coverage for low-income Mainers so they can access the health care services they need to work, care for family, go to school, and participate in the community. OMS works collaboratively with other State agencies, the Legislature, the Office of the Governor, MaineCare members, health care providers, and other health care purchasers on statewide healthcare improvement initiatives. OMS is committed to advancing health equity efforts to improve access to care and positive health outcomes for all low-income Mainers. OMS provides benefit coverage and support services in alignment with Department goals, federal requirements, and State statutes. OMS also provides oversight necessary to ensure accountability and efficient and effective administration of the state’s Medicaid program. The Rate Setting unit is located within the OMS Data Analytics team. Rate Setting oversees the implementation and operations of MaineCare’s rate system and other key DHHS reimbursement initiatives. Rate Setting objectives are to streamline, rationalize, and improve MaineCare’s reimbursement system to ensure rates are equitable and adequate to provide all MaineCare members with access to needed, high value healthcare services. MaineCare’s Rate Setting team plays a pivotal role in shaping how hospitals across the state are reimbursed, the financial health of Maine’s hospital system, access to hospital services, and the sustainability of Medicaid services. Application Information: For additional information about this position please contact David Jorgenson, at (207) 557-1258. Please submit all documents or files in PDF or Word format. To request a paper application, please contact 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%-100% of employee-only premiums ($12,845.82 - $15,112.76 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 ($395.72 annual value). Retirement Plan – The State contributes the equivalent of 18.91% 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—receive 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 an extensive 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 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. . If you are unable to complete the online application, please contact the Human Resources representative listed on the job opening you are interested in applying for. They will work with you for an alternative method of submitting.

Hospital Reimbursement Specialist job opportunity at Maine.

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