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claims analyst Denver, CO

State of Colorado

Full Time Denver, CO 72840 - 56028 USD ANNUAL Today

Job description

Department Information

STATE OF COLORADO RESIDENCY REQUIRED AT TIME OF APPLICATION

NOTE: This announcement may be used to fill multiple openings.

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.

We are committed to increasing the diversity of our staff and providing culturally responsive programs and services. Therefore, we encourage responses from people of diverse backgrounds and abilities.

We are looking for an Escalated Claims Analyst to join our Operations- Fiscal Agent Operations Work Unit within the Medicaid Operations Office!

This work unit exists to manage and enhance the current computerized claims processing and information management systems and implement and maintain the Colorado interchange system in order to assure timely and accurate Medicaid and Child Health Plan Plus (CHP+) claims processing in an environment of rapid policy change, improved budget forecasting and monitoring capabilities, and improved management of a Medicaid program. The work unit is responsible for monitoring the fiscal agents' performance under the terms and conditions of the contract. Additionally, the work unit directs and supports the various State and Federal audits of the Medicaid Management Information System (MMIS) and resulting Medicaid claims reimbursement, provider enrollment and medical benefit coverage.

As part of the State of Colorado, HCPF offers a competitive benefits package:

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

This position can work fully remotely from anywhere in the State of Colorado.

**Please note - equipment provisioning and certain onboarding tasks will take place in person, in our downtown Denver office, on the first day of employment.**

Description of Job

This position exists to monitor the Fiscal Agent for issues regarding provider enrollment, provider maintenance activities, standard operating procedures, claim payments, escalated claims, appeals and provider assistance.

Duties include, but are not limited to:

Initiating quality process assessment and ensuring that transmittals between the Department and the Fiscal Agent are completed timely and accurately.
Improving Department process Instructions to the Fiscal Agent.
Overseeing the Fiscal Agent performance statistics for the section.
Ensuring accurate processing of the fingerprinting background check and screening results of all provider enrollments.
Assisting providers and billing personnel with concerns regarding provider enrollment and claims payment.
Assisting providers and department staff with eligibility mismatches between CBMS and interchange.
Assisting other section staff with projects related to claims payment and provider enrollment.

Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights

Education and Experience:

Bachelor's degree from an accredited institution in a field of study related to the work assignment.

AND

Two years of professional experience in an occupational field related to medical billing, claims operations, provider coding, and/or claim operations.

Substitutions:

Additional appropriate experience will substitute for the degree requirement on a year-for-year basis.

Additional appropriate education will substitute for the required experience on a year-for-year basis.

PREFERRED QUALIFICATIONS

Prior state experience related to the duties of this position
Professional experience in a medical office
Professional experience with health insurance
Professional experience with insurance claims, appeals, regulations, and/or Standard Operating Procedures (SOP) compliance

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.

CONDITIONS OF EMPLOYMENT

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 disciplinary 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:

If you receive notice that you have been eliminated from consideration for this position, you may file an appeal with the State Personnel Board or request a review by the State Personnel Director.

An appeal or review must be submitted on the official appeal form, signed by you or your representative. This form must be delivered to the State Personnel Board by email ([email protected]), postmarked in US Mail or hand delivered (1525 Sherman Street, 4th Floor, Denver CO 80203), or faxed (303.866.5038) within ten (10) calendar days from your receipt of notice or acknowledgement of the department’s action.

For more information about the appeals process, the official appeal form, and how to deliver it to the State Personnel Board; go to spb.colorado.gov; contact the State Personnel Board for assistance at (303) 866-3300; or refer to 4 Colorado Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, at spb.colorado.gov under Rules.

Supplemental Information

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, Virginia Miller, at [email protected].

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

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