MEDICAID MANAGER FOR THIRD PARTY LIABILITY UNIT

Department of Health and Human Services (DHHS)

Asst. Div. Director Medicaid/Medicare Services

Opening Date: September 16, 2024

Closing Date: September 27, 2024

Job Class Code: 4204
Grade:  28
Salary: $63,689.60 – $90,438.40 per year

Position Number: 02000-1906

Location: Augusta

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 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 Third-Party Liability (TPL) team is comprised of four business units, the Private Health Insurance Premium benefit program (PHIP), Estate Recovery, Casualty Recovery, and Insurance, Long Term Care and Recovery and Audit. The position supervises staff in each of these business units and manages the vendor contract for hospital and long-term care audits and is responsible for contract renewals and development and issuance of RFPs.  The position reviews and approves invoice payments and participates on the fiscal agent team for TPL. The position develops monthly reports for TPL recovery activity and collaborates with the Attorney General’s office and other Office of MaineCare divisions.  The position works with Gainwell Technologies and our Change Management Unit on TPL processes and meets with them as needed to assure compliance with state and federal requirements.  The position works with state and federal auditors to address concerns or findings regarding TPL activity and collaborates with the Change Management Unit in developing Change Requests (CRs) for TPL transactions in MIHMS.

Core Responsibilities:

This is professional services work of a supervisory nature in assisting in the administration of Medicaid/Medicare Third Party Liability programs and services.  Responsibilities include directing and overseeing day-to-day activities, assisting in designing or amending Medicaid/Medicare TPL programs and services, developing and amending fines and sanctions, evaluating program progress and effectiveness, and supervising a professional staff.  Expectations include the application of good customer service skills in all contacts with clients, co-workers, stakeholders, and the public.  Work is performed under limited supervision.

Regular duties include:
•    Supervising 11 staff to ensure that work is appropriately prioritized, scheduled, and executed according to established workplans and deadlines.
•    Delegates and supervises distribution of daily workload.
•    Reviews and reports Long Term Care and Cost of Care audit results from Health Management Systems/Gainwell Technologies to the Department Finance Center monthly.
•    Works to resolve provider disputes of audit findings.
•    Provides monthly TPL recovery reports, Estate Recovery reports, Insurance Recovery & Audit reports, PHIP reports and ad hoc reports to Associate Director, Division of Operations. 
•    Creates and maintains databases and Excel spreadsheets of staff cases and recoveries.
•    Completes research projects as assigned and within specified timelines.
•    Manages Estate Recovery petty cash account.
•    Assists Associate Director of the Division with operationalizing policy changes required by state and/or federal regulators.  
•    Escalates difficult cases to Associate Director and/or Attorney General’s Office for legal advice.
•    Meets with Associate Director to assess productivity, challenges, and opportunities for improvement. 
•    Implements and complies with human resources policies and procedures for recruitment, position classification, performance appraisals, training, discipline, employee development, contract administration, safety, and information confidentiality and security, 
•    Reviews and approves work and contract-related deliverables to ensure they are complete, accurate, and meet requirements.
•    Provide direction on escalated issues, questions, and decisions.
•    Collaborate with other Department or State teams as needed on cross-agency or cross-Department initiatives.

This position reports to the Associate Director, Division of Operations.     

Minimum Qualifications:

A Bachelors Degree in Health or Hospital Administration, or related field and four (4) years professional experience in medical and/or health care administration to include three (3) years in a supervisory capacity.

Thinking about applying?

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Application Information:

 Please submit all documents or files in  PDF format.

For questions, please contact Roger Bondeson at 207-287-2705

To request a paper application, please contact Ashley.Smith@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—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.