JOB
STATE OF COLORADO RESIDENCY REQUIRED AT TIME OF APPLICATIONNOTE: This announcement may be used to fill multiple openings.Envision Yourself Working at HCPFThe 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. 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 plansMedical, Dental, and Vision insurance coverageAutomatic Short-Term and Optional Long-Term Disability CoverageLife and AD&D InsuranceFlexible 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 LeaveAccrued Sick Leave for State of Colorado Temporary EmployeesFlexplace and Flextime work arrangementsVariety of discounts on services and products available through the State of Colorado's Work-Life Employment Discount ProgramFree RTD EcoPass to all eligible State EmployeesReduced college tuition through CSU GlobalCredit Union of Colorado Membership EligibilitySome 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-programsWe are looking for a Child & Maternal Health Systems Business Analyst for the Systems Division of the Health InformationOffice (HIO)!The Systems Division of HIO exists to manage and enhance computerized claims processing and information management systems in order to assure timely and accurate Medicaid, Child Health Plan Plus (CHP+), and Colorado Department of Human Services (CDHS), Behavioral Health Administration (BHA) claims processing and payments in an environment of rapid policy change. It also exists to improve budget forecasting and monitoring capabilities and improve program management of Medicaid Enterprise System (MES) programs with an annual budget of over ten billion dollars. The work unit is responsible for researching, verifying and validating the technical functions of the Colorado Medicaid enterprise and subsystems, evaluating project requests, eliciting requirements for Medicaid Management Information System (MMIS) change requests and managing change through the system development life cycle. The work unit coordinates with internal and external stakeholders, the MMIS vendor, other system vendors and work units, and the Department’s UAT, Case & Care Management (CCM) and MES Integration & Data Alignment (MIDA) work units to deliver high quality, compliant changes to the MMIS system. Additionally, the work unit supports the various State and Federal audits of the Department’s systems and programs, resulting in medical claims reimbursement, provider enrollment and medical benefit coverage.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.**
EXAMPLE OF DUTIES
WHAT YOU'LL BE DOING AS CMH SYSTEMS BUSINESS ANALYST: Serve as the CMES Child and Maternal Health & Cover All Coloradans Staff Authority for the Department, and is responsible for the system enhancement and system operations work related to this population. Document and enforce system policies and business rules that ensure member access to care and provider payment, and ensure that payments for this population are reported accurately.Lead all interChange Payers to evaluate policies that conflict with CMS rules and ensure that system change does not affect CMS certification or funding. Guide the Medicaid/CHP+ program, operations and finance teams to evaluate options that are compliant and meet the needs of the program.Report of coordination of benefits (COB), and work directly with both external and internal Payers to ensure the accurate reporting of claims and encounters. Manage the integration enhancements to CMES modules that impact member access to care, provider payment or financial reporting, as well as the enhancements that impact Health Plan Payers solutions. Relied on by Management to make system change decisions and recommendations, and to direct activities that support policy alignment of Cover All Coloradans and Child and Maternal Health programs. Determine the plan for elicitation and documentation of policies, rules, regulations and business requirements needed to maintain accurate, timely, and compliant reporting of claims and encounters, COB and TPL data affecting a member’s access to care, provider payment and federal reporting. Determine stakeholder management and risk management activities needed to receive approval of the business requirements from the customer.Verify the fiscal agent's solution meets Cover All Coloradans programs policies, rules, regulations and business requirements. Communicates and determines the test planning approach for Health Plan System testing efforts with program and financial reporting stakeholders, the interChange vendor, the Medicaid Operations Office (MOO), the System Integrator Team, RAEs, MCOs and Service Organizations.
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 ProcessThe 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, Anupreet Kaur, at anupreet.kaur@state.co.us.The Department of Health Care Policy & Financing does not offer sponsored visas for employment purposes.
