Provider Relations Specialist

MaineCare Provider Policy SpecialistDepartment of Health and Human Services (DHHS)Opening Date: August 21, 2026Closing Date: September 3, 2026Job Class Code: 5011Grade: 20 (Professional & Technical)Salary: $20.68 – $28.88 per hourPosition Number: 02000-2530Location: AugustaCurrently, this position is not eligible for visa sponsorship or STEM OPT extensions.Core Responsibilities:This position reports to the Provider Services Manager and is responsible for developing and maintaining expertise in an assigned set of provider types and policies. The individual will provide support for these assigned areas while also developing knowledge of and supporting policies shared across the team.The position will also require a working knowledge of MaineCare member eligibility requirements and classifications to support accurate and effective claims analysis. The individual must be able to manage multiple and evolving priorities in an organized and efficient manner while maintaining composure, professionalism, and sound judgment when addressing challenging situations.Regular duties include:• Interpreting and applying MaineCare policies, with a primary focus on the MaineCare Benefits Manual, and providing clear, accurate, and timely guidance to MaineCare providers. This includes communicating policy requirements, clarifying applicable guidance, and assisting providers in understanding their responsibilities and compliance obligations. The position will ensure that provider communications are consistent with established MaineCare policies and procedures and are presented in a clear and professional manner.• Researching complex claims data by exporting claims data onto spreadsheets, analyzing claims data, assessing root cause and remediation, and assisting providers with resolution.• Collaborating effectively with internal teams across the Office of MaineCare Services (OMS) and the Department of Health and Human Services (DHHS), as well as external vendor partners, to research, analyze, and resolve complex claims issues. This includes working closely with teams responsible for claims processing, policy development and interpretation, utilization management, rate setting, and prior authorization to identify root causes, clarify requirements, and develop appropriate and timely resolutions. The position will also participate in cross-functional workgroups and project teams supporting large-scale initiatives, system changes, policy implementations, and other organizational priorities as needed.• Utilizing strong verbal and written communication skills to develop and present provider training and educational materials on MaineCare policy and claims and billing. Training may be for individual providers or for groups, both on-site and virtually.• Assisting providers to determine the appropriate provider type and specialty under which to enroll with MaineCare, as determined by the services the provider renders.• Representing OMS and the Department by participating in provider forums, stakeholder groups, provider association meetings, and other external meetings to both share policy and billing information and to gather information about policy or billing issues.Minimum Qualifications:A four (4) year combination of training and experience providing a knowledge of health care administration and community health services.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 coverageThe background of well-qualified candidates will demonstrate the following competencies:1. A proven ability to investigate and resolve complex medical insurance claims billing issues, and a thorough knowledge of MaineCare provider policies, programs, guidelines, procedures, and processes or similar knowledge in a commercial health plan environment2. A demonstrated ability to develop and deliver adult training programs to diverse audiences, including comfort with Microsoft PowerPoint3. Strong analytical and problem-solving skills, including comfort with Microsoft Excel4. Ability to foster collaborative working relationships with both internal and external stakeholders5. Ability to work independently on multiple projects while maintaining progress on daily work.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.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 health insurance coverage for low-income families, adults and children so they can access the important health care services they need to be healthy and be a part of the community through work, caring for family, going to school, and more. OMS works collaboratively within DHHS, with other Departments and the Office of the Governor, with MaineCare members, with providers, and with other health care purchasers on statewide healthcare improvement initiatives. OMS is committed to advancing health equity efforts to improve access to care and health outcomes for all low-income Mainers. OMS provides benefit coverage and supports the services that operate in alignment with Department goals, federal mandates and State policy. OMS also provides oversight necessary to ensure accountability and efficient and effective administration.The Provider Relations Unit within OMS supports health care providers enrolled with MaineCare by providing education, training, and research on MaineCare policy interpretation, enrollment, claims and billing guidance, and complex claim resolution, with a goal to help MaineCare providers bill appropriately and in compliance with MaineCare policy.Application Information:For additional information about this position please contact Heidi Brann, at View phone number on click.appcast.io.Please submit all documents or files in a PDF or Word format.To request a paper application, please contact View email address on click.appcast.io 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 and 3+ weeks of vacation leave annually. Vacation leave accrual increases with years of service, and overtime-exempt employees receive personal leave. When you or immediate members of your family are ill, utilize 12 days of sick leave per year.Health Insurance Coverage – The State of Maine pays 85%-95% of employee-only premiums ($12,213.60 - $13,650.48 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 ($365.28 annual value).Retirement Plan – The State contributes the equivalent of 14.06% of the employee's pay towards the Maine Public Employees Retirement System (MainePERS), on behalf of the employee.Gym Membership Reimbursement – Improve overall health with regular exercise and receive up to $40 per month to offset this expense.Health and Dependent Care Flexible Spending Accounts – Set aside money pre-tax to help pay for out-of-pocket health care expenses and/or daycare expenses.Public Service Student Loan Forgiveness – The State of Maine is a qualified employer for this federal program. For more information, visit the Federal Student Aid office.Living Resources Program – Navigate challenging work and life situations with our employee assistance program.Parental leave is one of the most important benefits for any working parent. All employees who are welcoming a child—including non-birthing 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.Voluntary Deferred Compensation – Save additional pre-tax funds for retirement in a MaineSaves 457(b) account through payroll deductions.