Department of Health and Human Services (DHHS)
Opening Date: September 2, 2022
Closing Date: September 16, 2022
Job Class Code: 0441
Grade: 20
Salary: $39,395.20 – $52,894.40/year
Position Number:
Agency information:
The Department of Health and Human Services (DHHS) provides supportive, preventive, protective, public health and intervention services that help families and individuals 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, 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 Drug Rebate Program is part of the Pharmacy Unit, within OMS. Drug Rebate is a program that includes Centers for Medicare & Medicaid Services (CMS), State Medicaid agencies, and participating drug manufacturers that helps to offset the Federal and State cost of most outpatient prescription drugs dispensed to Medicaid patients.
Job duties:
This position administers the Drug Rebate Program for the State of Maine. Responsibilities include, but are not limited to, submitting drug rebate invoices to participating drug manufacturers. Allocating and reconciling payments from drug manufacturers. Researching and analyzing national drug code (NDC) reports, paid claim information, and drug pricing and packaging information whenever a drug manufacturer disputes invoiced amounts. Negotiating and resolving disputed units with drug manufacturers and pharmacies. You will evaluate and interpret State and Federal statute, rules, and laws to comply with required procedures. Attention to detail is a must, as is the ability to handle a large volume of work and to make decisions independently. Additional duties are described below.
- Provide detailed reports of drug utilization as requested by manufacturers so they may review the data prior to paying a rebate.
- Resolve disputes when the manufacturer disputes the invoiced total units. This may require contacting a pharmacy to verify a member’s prescription of what was dispensed.
- Review outstanding balances to see if a manufacturer has credits on file or owes a balance.
- Provide claim level detail (CLD) reports to support the invoiced amount.
- Respond timely to questions from manufacturers.
- Request invoice backup from the manufacturer so that a payment may be allocated correctly and reconciled.
This position reports to the Pharmacy Operations Manager. This is a full-time position located at 109 Capitol Street, Augusta, Maine. This opportunity allows partial telework with management approval.
Minimum Qualifications:
A Bachelor’s Degree in Accounting, Business Administration or related field and one (1) year of experience in healthcare insurance or a related insurance field. Directly related work experience may be substituted for education requirements 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:
- As a Reimbursement Specialist you frequently communicate by phone and in writing with physicians, pharmacists, drug labelers/manufacturers, attorneys, and federal CMS (Centers for Medicare and Medicaid Services). To successfully perform these duties, you will need strong oral and written communication skills. Please tell us about those aspects of your background that demonstrate you have the oral and written communication skills to be successful as a Reimbursement Specialist.
- Reimbursement Specialists are independent and self-directed workers who operate with considerable autonomy in establishing their day-to-day work activities and priorities. Please provide us with examples from your experience that demonstrate you are a self-directed worker capable of successfully performing your duties with minimal supervision.
- Reimbursement Specialists negotiate with drug labelers/manufacturers and federal CMS representatives in order to collect money for disputed payment amounts on drug invoices. Maintain two-way communications with them and use problem-solving techniques in order to negotiate a dispute resolution. Tell us about those experiences that demonstrate you can successfully perform duties requiring considerable research and negotiation skills.
- Drug manufacturers often challenge the Department’s attempt to recover delinquent accounts. As a Reimbursement Specialist, you will analyze quarterly drug rebate invoices for approximately 780 participating drug manufacturers for 4 different rebate programs. You will record and reconcile payments using knowledge of proper accounting principles. Analyze balances after posting payment in order to identify disputes and reasons for disputes. Please tell your experiences that demonstrate effective accounting principles.
- Reimbursement Specialist must have pharmacy knowledge and an understanding of a preferred drug list. They should be able to review pharmacy claims and have an understanding of a pharmacy formulary and/or preferred drug list in order to respond to drug manufacturers. Please tell your experience that demonstrate proficient pharmacy experience.
Application Information:
Please submit all documents or files in a PDF or Word format.
For additional information about this position please contact Jan Wright at or by e-mail . To apply, upload a resume and cover letter addressing the five competency areas identified in the above section.
To request a paper application, please contact .
Benefits
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 Balance – 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 ($10,150.80-$11,345.04 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 ($350.40 annual value).
- Retirement Plan – The State of Maine contributes 13.16%of pay to 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 fathers and adoptive parents-receive four 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.
- Learn about additional wellness benefits for State employees from the Office of Employee Health and Wellness.
Maine State Government is an Equal Opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees….. click apply for full job details