Community Living Operations and Enrollment Analyst

About the Department

STATE OF COLORADO RESIDENCY REQUIRED AT TIME OF APPLICATION

Envision yourself working at HCPF

The State of Colorado strives to create a Colorado for All by building and maintaining workplaces that value and respect all Coloradans through a commitment to equal opportunity and hiring based on merit and fitness. The State is resolute in non-discriminatory practices in everything we do, including hiring, employment, and advancement opportunities.

The Department of Health Care Policy & Financing (HCPF) oversees and operates Health First Colorado (Colorado's Medicaid Program), Child Health Plan Plus (CHP+), and other state public health programs for qualified Coloradans. Our mission is to improve health care equity, access and outcomes for the people we serve while saving Coloradans money on health care and driving value for Colorado. 

• PERA retirement benefits including PERA Defined Benefit Plan, PERA Defined Contribution Plan, plus 401K and 457 plans

• Medical, Dental, and Vision insurance coverage

• Automatic Short-Term and Optional Long-Term Disability Coverage

• Life and AD&D Insurance

• Flexible Spending Accounts (FSAs)

• Family Medical Leave Act (FMLA) job protection and State of Colorado Paid Family Medical Leave (PFML)

• 11 Paid Holidays Annually and Accrued Annual and Sick Leave

• Accrued Sick Leave for State of Colorado Temporary Employees

• Flexplace and Flextime work arrangements

• Variety of discounts on services and products available through the State of Colorado's Work-Life Employment Discount Program

• Free RTD EcoPass to all eligible State Employees

• Credit Union of Colorado Membership Eligibility

• Some positions may qualify for the Public Service Loan Forgiveness Program. For more information, go to https://www.colorado.gov/pacific/dhr/student-loan-forgiveness-programs.https://dhr.colorado.gov/dhr-resources/student-loan-forgiveness-programs

We are onboarding new employees using a hybrid approach. The Department supports flexible work arrangements. Depending on the business need and description of the position, we have options that range from hybrid to full-time in the office. Specific discussions about the schedule will be discussed during the offer stage. 

Position Duties

Position Summary

Provides leadership and oversight for provider enrollment operations related to Home and Community Based Services (HCBS), Money Follows the Person (MFP), and Community First Choice (CFC) programs. Determines when provider and staff training materials require development or revision and leads training on the Medicaid Management Information System (MMIS) provider enrollment module. Monitors provider enrollment progress, collaborates with the Colorado Department of Public Health and Environment to ensure effective enrollment processes, and directs claims data analysis related to credentialing concerns. Oversees provider capacity-building initiatives by initiating scope change requests, manages biannual updates to the Provider Enrollment Grid to maintain compliance with regulatory and statutory requirements, and determines when enrollment changes necessitate updates to billing manuals, training materials, public-facing web content, and provider communications regarding system and enrollment changes.

• This position exists as the Department staff authority on initial and ongoing enrollment and revalidation of Health First Colorado HCBS, CFC, and MFP Providers and Case Management Agencies that support eligible Medicaid and State General Fund participants.  
• Ensures all provider-submitted enrollment documents comply with relevant federal and state requirements, 
• The position establishes the standards for, and subsequently develops, technical assistance materials for providers enrolling as Health First Colorado providers, working closely with Benefit and Case Management Division staff to ensure alignment with regulatory requirements for the HCBS waivers and other regulatory authorities.   
• As the Department staff authority on HCBS, CFC, MFP, and Case Management provider credentialing, the role determines whether rule changes related to HCBS provider enrollment are needed, and manages all aspects of rule changes in concert with Benefits and Case Management Division staff responsible for waiver amendments and individual benefits.  
• Role also provides subject matter expertise to benefit managers responsible for the 1915(i) waiver documents that govern the Department’s services and supports all requests for information required to maintain federal compliance.  

• Initiates and manages process improvements to ensure efficient use of Department and provider resources. 

• Role also functions as Department lead on fraud referral and provider credentialing revocation. Work extends to coordination with the Department’s Program Integrity group and the Colorado Department of Public Health and Environment in the event there are issues with the validity of a provider’s enrollment information or if fraudulent billing activity is suspected. 

• In working with the Colorado Department of Public Health and Environment, role initiates and has oversight for, monthly meetings with the Colorado Department of Health and Environment to monitor and track the progress of HCBS providers enrolling as providers, as well as the status of providers under review or at risk for termination. 

• Leveraging data from enrollment information and claims data, the position leads the Department in developing strategies for provider capacity building, as well as determining when changes to the Medicaid Management Information System are needed to support effective and efficient provider enrollment activities, seeing all work through the Software Development Lifecycle (SDLC). 

• Manages project plans and tracking mechanisms necessary to see all projects through to completion. 

• Role is responsible for the development, maintenance, and deployment of internal-facing documentation regarding enrollment. 

• Role directs the training of Benefits Division and Case Management Division staff as needed to support revalidation and enrollment work. Responsibilities extend to cross training other Systems Unit staff, including the Community Living Business and Operations Analyst. 
• Role also determines, and recommends to senior Office leadership, when additional staffing is needed for revalidation and enrollment activities. Role is responsible for training and acting as a lead to these resources, overseeing their work as needed. 
• Position leads initial and ongoing system training for Office staff, as they are the Office expert on the end-to-end enrollment and credentialing operations that are integrated into the Department’s IT systems.  
• Role’s expertise ensures that the system is operating in accordance with Office of Community Living business processes and statutory/regulatory requirements.  
• Role leverages expertise to determine and initiate communication with the Health Information Office Care and Case Management Team and the Health Information Office Medicaid Management Information System (MMIS) Subject Matter Expert to ensure systems efficiency.  
• Role leads participation in User Acceptance Testing as performed by Office staff relative to changes to the enrollment module, and the determination of how changes drive needed updates to billing manuals and external-facing web resources.  
• Role provides initial claims research and troubleshooting for Office staff, helping to resolve issues quickly to provide optimal customer service to staff and end users of the system. Role responsible for managing system performance through the review and management of data points that identify potential problems. 
• Position leads Office efforts related to the drafting of Scope Change Requests to initiate needed changes to the various systems and subsystems that interface with the Medicaid Management Information System.  
• Position discerns when an issue is best resolved through process change or if systems changes are the only alternative.  
• Role leads and manages all tracking of developed documents related to needed systems changes, ensuring that all impacted Office staff have been engaged and their feedback incorporated accordingly. Work extends to the provision of prioritization recommendations to senior Office management about how best to prioritize resources and manage projects. 
• Role leads project coordination across the Office once a system change has been prioritized by Department management, in close coordination with Health Information and Medicaid Operations Office staff, with efforts extending to requirements validation and testing. 
• Position leads post-implementation monitoring to ensure base functionality and process performance is preserved, with work extending to monitoring provider feedback. 

Minimum Qualifications

MINIMUM QUALIFICATIONS:

There are two ways to qualify for this position:

Option 1:

Experience Only:

Seven (7) years of related professional experience interpreting regulations, analyzing data, implementing process improvements, and communicating policy and/or or system changes.

Option 2:

Education and Experience:

A bachelors degree from an accredited institution in Business Administration, Public Health, Public Policy, Social Services AND  three (3) years of professional experience interpreting regulations, analyzing data, implementing process improvements, and communicating policy and/or or system changes.

Appropriate education will substitute for the required experience on a year-for-year basis. Relevant education will be calculated as the following:

• An associate will count as two years of experience

• A bachelors will count as four years of experience

• A masters degree will count for six years of experience

• A doctorate or juris doctorate degree will count for seven years of experience

• Note: Per the Job Application Fairness Act, you may redact information that identifies your age, date of birth, or dates of attendance at or graduation from an educational institution on your transcripts.

PREFERRED QUALIFICATIONS

• Prior experience working as a case manager supporting individuals in Home and Community Based Services (HCBS) to select providers.

• Prior experience providing or validating business analysis and support for large Healthcare IT systems that facilitate Provider Enrollment, Prior Authorization (PAR) and medical claims processing, and/or Care and Case Management Systems. Experience can extend to end users of these systems.

• Prior experience working with medical provider enrollment and/or provider licensure. 

• Current or previous State experience.

DEFINITION OF PROFESSIONAL EXPERIENCE: Work that involves exercising discretion, analytical skill, judgment, personal accountability, and responsibility for creating, developing, integrating, applying, and sharing an organized body of knowledge that characteristically is uniquely acquired through an intense education or training regimen at a recognized college or university; equivalent to the curriculum requirements for a bachelor's or higher degree with major study in or pertinent to the specialized field; and continuously studied to explore, extend, and use additional discoveries, interpretations, and application and to improve data, materials, equipment, applications and methods. 

• All positions at HCPF are security sensitive positions and require that the individuals undergo a criminal record background check as a condition of employment.
• Employees who have been disciplinarily terminated, resigned in lieu of disciplinary termination, or negotiated their termination from the State of Colorado must disclose this information on the application.

APPEAL RIGHTS:

An applicant who has been removed from an employment list or removed from consideration during the selection process may request a review by the State Personnel Director.

As an applicant directly affected by the results of the selection or comparative analysis process, you may file a written appeal with the State Personnel Director.

Review of the completed, signed and submitted appeal will be timely on the basis of written material submitted by you, using the official appeal form signed by you or your representative. This form must be completed and delivered to the State Personnel Board by email at [email protected] within ten (10) calendar days from your receipt of notice or acknowledgement of the Department’s action.

Other Qualifications

How to Apply (PLEASE READ CAREFULLY)

Please note that ONLY your State of Colorado job application will be reviewed during the initial screening; if you submit a resume and cover letter, they will be reviewed in later stages of the selection process. Therefore, it is paramount that you clearly describe all your relevant experience on the application itself. Applications left blank or marked "SEE RESUME" will not be considered.

Your application will be reviewed against the minimum qualifications for the position. If your application demonstrates that you meet the minimum qualifications, you will be invited to the comparative analysis process, which is described below.

Comparative Analysis Process

The comparative analysis process will consist primarily of a review of applications against the minimum and preferred qualifications of this position. Applications will be reviewed in comparison to all others in the applicant pool in order to identify a top group of candidates who may be invited for a final interview. Depending on the size of the applicant pool, additional selection processes may be utilized to identify a top group of candidates. Applicants will be notified of their status via email.

Failure to submit properly completed documents by the closing date will result in your application being rejected.

ADAAA Accommodations: The State of Colorado believes that equity, diversity, and inclusion drive our success, and we encourage candidates from all identities, backgrounds, and abilities to apply. The State of Colorado is an equal opportunity employer committed to building inclusive, innovative work environments with employees who reflect our communities and enthusiastically serve them. Therefore, in all aspects of the employment process, we provide employment opportunities to all qualified applicants without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity or expression, pregnancy, medical condition related to pregnancy, creed, ancestry, national origin, marital status, genetic information, or military status (with preference given to military veterans), or any other protected status in accordance with applicable law.

The Department of Health Care Policy & Financing is committed to the full inclusion of all qualified individuals. As part of this commitment, our agency will assist individuals who have a disability with any reasonable accommodation requests related to employment, including completing the application process, interviewing, completing any pre-employment testing, participating in the employee selection process, and/or to perform essential job functions where the requested accommodation does not impose an undue hardship. If you have a disability and require reasonable accommodation to ensure you have a positive experience applying or interviewing for this position, please direct your inquiries to our ADAAA Coordinator, Minnie Kaur, at [email protected].

The Department of Health Care Policy & Financing does not offer sponsored visas for employment purposes.

Benefits

The State of Colorado offers permanent employees a variety of benefits including medical, dental, life and disability insurance, as well as a comprehensive leave program.  Please click the following link for detailed information:  www.colorado.gov/pacific/dhr/benefits 

Please note that each agency's contact information is different; therefore, we encourage all applicants to view the full, official job announcement which includes contact information and class title. Select the job you wish to view, then click on the "Print" icon.
 

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