Fee-for-Service Claims & Payment Models Business Analyst.

Department Information

State Of Colorado Residency Required At Time Of Application

Envision Yourself Working at HCPF

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.

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
• Reduced college tuition through CSU Global
• 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 looking for a Fee-for-Service Claims & Payment Models Business Analyst for the Business Solutions Division of the Health Information Office (HIO)!

The Business Solutions Division of HIO manages and enhances computerized claims processing and information management systems that support the Department’s compliant administration of the state’s medical assistance programs including Health First Colorado and Child Health Plan Plus (CHP+). The work unit supports multiple state agencies that utilize CMES services including the Colorado Department of Human Services (CDHS) and the Behavioral Health Administration (BHA). The unit evaluates budget and funding constraints that create risks to the timely delivery of a compliant system, and supports budget, contracting and procurement teams in forecasting the capacity needs for HIO and CMES module vendors in order to achieve operational excellence. The work unit is responsible for ensuring the operation of the CMES Modules meet the business needs of the Department, stakeholders, health plan payers and providers, case managers and other system users. In order to minimize the disruption of services and operations, the work unit must balance these business needs with the need to deliver a compliant system that adheres to the Department’s data governance policies and the security standards of the Governor’s Office of Information Technology (OIT).

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

WHAT YOU'LL BE DOING AS FFS CLAIMS & PAYMENT MODELS BUSINESS ANALYST:

• Staff Authority for interChange Fee-For-Service (FFS) Claims and Payment Models, relied on by HCPF management to ensure providers are paid accurately for claims processed within the interChange.
• Manage the HCPF claims processing system and the policies, programs, benefits and payment models that affect accurate and timely provider payment in order to ensure accurate payments.
• Make determinations that support interChange system changes related to these policies and payment models, with continual responsibility for the work product related to FFS claims processing and pricing within the interChange system for HCPF.
• Elicit, review, and document policies, rules, regulations and business requirements supporting the reference data, edits, audits and business rules affecting claims processing and provider payment. After receiving approval of the business requirements from the customer, assist and validate the test scenarios and test cases with the Department’s User Acceptance team.
• Direct efforts to document and manage the Department’s business requirements for for claims pricing models (APR-DRG, EAPG, FQHC, APMs, VBP, DME, etc), provider payments, and claims data within the interChange, the definition process for system change with the interChange vendor, and the transition of the requirements for operational readiness into the maintenance and operations phase.
• Verify the fiscal agent's solution meets HCPF policies, rules, regulations and business requirements.
• Direct efforts with program Stakeholders, the interChange vendor, the Medicaid Operations Office (MOO), and the Enterprise Solution Integration (ESI) teams, to ensure MMIS subsystems are aligned with HCPF requirements.
• Exert expertise in the technical aspects of interChange claims processing system, interfaces, payment models (including Outpatient EAPG, Inpatient DRG, Specialty Hospitals, location based pricing models, Alternative Payment Methodologies (APMs), Value Based Payment Methodologies (VBP) and a number of hybrid options that are required for compliance with CMS), and FFS data.
• Ensure system change is documented and traceable from scope and requirements, to design and testing.
  
  

Residency Requirement

Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights

This posting is only open to residents of the State of Colorado at the time of submitting your application.

Class Code & Classification Description

H1C4XX ANALYST IV

Minimum Qualifications

There are two ways to qualify for this position:

Option 1

Experience Only:

Seven (7) total years of professional experience in Business Analysis, Project Management, Product Management, Health Care Claims Analysis, and/or System Quality Assurance Testing.

Option 2

Education and Experience:

Bachelor's degree from an accredited institution in Business Administration, Public Health, or a field of study related to the work assignment

AND

Three (3) total years of professional experience in Business Analysis, Project Management, Product Management, Health Care Claims Analysis, and/or System Quality Assurance Testing.

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

• An associates 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
  
  

Preferred Qualifications

• Previous relevant professional state experience
• Professional experience with:
• Working as a Systems Business Analyst
• Documenting business requirements for large scale medical claims processing system or medical information system
• Stakeholder management, risk management or project management
• Working for or in partnership with a State Medicaid Agency
  

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 ( dpa_state.personnelboard@state.co.us ), 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 virginia.miller@state.co.us .

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