Provider Relations Payment Error Rate Specialist (PERM)

If you are a current State of Maine employee, please submit your application through the internal application process using the Find Jobs report in PRISM. Seasonal employees who do not have PRISM access should apply through the State's career page and indicate on the application that they have previously worked for the State..Department of Health and Human Services (DHHS)Provider Relations SpecialistOpening Date: September 9, 2026Closing Date: September 22, 2026Job Class Code: 5011Grade: 20 (Professional & Technical)Salary: $20.68 - $28.88 per hourPosition Number: 20002-5207Location: AugustaCurrently, this position is not eligible for visa sponsorship or STEM OPT extensions.Core Responsibilities:This position reports to the Provider Services Manager and position will focus on a targeted approach to providing the necessary training and education to reduce provider error rates relating to billing and documentation in compliance with H.R.1, Section 71106, for the Payment Error Rate Measurement (PERM) process and ultimately reducing and mitigating any State Medicaid risks of imposed penalties.

The position will also support the PERM Difference Resolution Process, which is the formal mechanism under the Payment Error Rate Measurement (PERM) program that allows states to challenge or clarify findings made by federal review contractors in Medicaid and CHIP audits.Training will be conducted in person, virtually, and through Statewide forums with a targeted focus on various examples of PERM errors and those providers may experience.

Strengthening these processes is critical to prevent future error rates from surpassing the 3% limit and protecting the state from potential penalties.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.This position will conduct outreach to providers to support the Medicaid Program Integrity Audit by sending communications to request documentation, maintain detailed record of outreaches and discussions, and analyze results of the documentation received.

Regular duties include:• Utilizing strong verbal and written communication skills to develop and present provider training and educational materials on the PERM process. Training may be for individual providers or for groups, both on-site and virtually.• Interpreting and applying MaineCare policies, with a primary focus on the MaineCare Benefits Manual, and providing clear, accurate, and timely guidance to MaineCare providers to support the PERM audit process.

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.• 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.• Representing OMS and the Department by participating in provider forums, stakeholder groups, provider association meetings, and o