Eligibility Quality Assurance Reviewer

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Eligibility Quality Assurance Reviewer

Salary

$57,708.00 - $75,024.00 Annually

Location

Denver Metro, CO

Job Type

Full Time

Job Number

UHA04550-11-2024

Department

Department of Health Care Policy and Financing

Division

Medicaid Operations Office

Opening Date

11/27/2024

Closing Date

12/9/2024 11:59 PM Mountain

FLSA

Determined by Position

Type of Announcement

This position is open only to Colorado state residents.

Primary Physical Work Address

303 E 17th Ave Denver, CO 80203

FLSA Status

Exempt; position is not eligible for overtime compensation.

Department Contact Information

Sarah Roman, Talent Acquisition Specialist sarah.roman@state.co.us

How To Apply

Please submit an online application for this position at https://www.governmentjobs.com/careers/colorado. Reach out to the Department Contact to apply using a paper application, including any supplemental questions. Failure to submit a complete and timely application may result in the rejection of your application. Applicants are responsible for ensuring that application materials are received by the appropriate Human Resources office before the closing date and time listed.

• Description

• Benefits

• Questions

Department Information

STATE OF COLORADO RESIDENCY REQUIRED AT TIME OF APPLICATION

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

Envision yourself working at HCPF (https://www.youtube.com/watch?v=5He6If7FyDY)

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: (https://dhr.colorado.gov/state-employees/state-of-colorado-employee-benefits)

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

• Medical (https://dhr.colorado.gov/state-employees/state-employee-benefits/medical-benefits) , Dental (https://dhr.colorado.gov/state-employees/state-employee-benefits/dental-insurance) , and Vision (https://dhr.colorado.gov/state-employees/state-employee-benefits/vision-insurance) insurance coverage

• Automatic Short-Term and Optional Long-Term Disability Coverage (https://dhr.colorado.gov/state-employees/state-employee-benefits/disability-insurance)

• Life and AD&D Insurance

• Flexible Spending Accounts (https://dhr.colorado.gov/state-employees/state-employee-benefits/flexible-spending-accounts) (FSAs)

• Family Medical Leave Act (FMLA) (https://dhr.colorado.gov/state-employees/time-off-leave/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 (https://dhr.colorado.gov/state-employees/time-off-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 (https://www.rtd-denver.com/fares-passes/ecopass) to all eligible State Employees

• Credit Union of Colorado (https://www.cuofco.org/credit-union-colorado-membership-eligibility) 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

TheEligibility Compliance Review Sectionis responsible for conducting federally required Medicaid Eligibility Quality Control (MEQC) and Express Lane Eligibility (ELE) audits and eligibility site reviews for the Department to ensure eligibility determinations are accurate and timely according to state and federal policy and guidance. This includes reviewing the Colorado Benefit Management System (CBMS) and interpreting eligibility state and federal regulations across several medical assistance programs to ensure compliance. The Section develops, coordinates, implements and conducts these eligibility reviews. The Section also works with the Center for Medicare and Medicaid Services (CMS), eligibility sites, Department staff and other stakeholders to communicate findings, ensure agreement to findings and request for corrective action plans

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.

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:

• Reviewing and tracking the accuracy of the Medical Assistance eligibility determinations to find and report compliance with federal and state eligibility rules and procedures on an ongoing monthly basis.

• Identifying and updating review requirements when eligibility rules or processes changes.

• Advising state and eligibility site administrators of review findings through individual case reports and project summary reports.

• Processing and responding to error rebuttals from eligibility sites.

• Monitoring the Eligibility Quality Assurance team's shared email inbox.

Flexibility for in-state travel with potential overnight duration may be necessary to attend/conduct onsite reviews, trainings, or conferences.

Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights

Residency Requirement:

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

MINIMUM QUALIFICATIONS:

There are two ways to qualify for this position:

Option 1:

Experience Only:

Six (6) years of professional experience in public assistance programs.

Option 2:

Education and Experience:

A bachelors degree from an accredited institution in a related field and two (2) years of professional experience in public assistance programs.

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

PREFERRED QUALIFICATIONS:

• Prior state experience related to the duties of this position

• Experience working with the Colorado Benefits Management System (CBMS) within the last seven years

• Experience with researching, reviewing, understanding and interpreting federal and state regulations for public assistance programs

• Experience performing quality reviews for Medical Assistance cases

• Experience communicating with external stakeholders

Highly Desired Knowledge, Skills, and Abilities:

• Demonstrated ability to meet hard deadlines, work with minimal supervision and maintain a focus on priorities in an environment of change

• Experience making decisions, documenting decisions, and explaining decisions to others

• Experience working closely with a team to accomplish shared goals

• Ability to be self-motivated and self-directed

• Strong communication skills, verbal and written

  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:

  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 dpa_state.personnelboard@state.co.us within ten (10) calendar days from your receipt of notice or acknowledgement of the Department’s action.

  For further information on the Board Rules, you can 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/board-rules .

Supplemental Information

How to Apply (https://careers.colorado.gov/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 (debra.becerra@state.co.us) .

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

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.

01

All HCPF positions are security-sensitive positions and require potential employees to undergo a criminal record background check. As a condition of employment, you will be required to submit to pre-employment screening if offered the position. Are you willing to meet this requirement?

• Yes

• No

  02

  Do you have any relatives or significant others working at the Department of Health Care Policy & Financing? If so, please list their names here. Otherwise, please list N/A

  03

  Per the requirements of the Step Pay Program implemented on July 1, 2024, any State employee must be paid a rate that is equal to or greater than the appropriate step pay rate within their classification's pay range based on completed years in their current class series as of June 30. All current and former State employees must ensure that your entire work history within the State Classified System, including at Institutions of Higher Education, is indicated in your application so that your time-in-series can be calculated accurately. Please verify that this information is included in your application in the supplemental questions

  04

  Are you willing to accept an offer within the posted salary range?

• Yes

• No

  05

  Former state employees who were disciplinarily terminated or resigned in lieu of termination must disclose the information on the application. In the space below, please provide an explanation as to why the prior termination or resignation should NOT disqualify your application from the current position. Otherwise, please list N/A.

  06

  Please explain how your professional experience addresses the preferred qualifications of working with a team to accomplish shared goals and possessing an ability to meet hard deadlines with minimal supervision. Responses should contain specific examples from your experience.

  07

  Please explain how your professional experience addresses the preferred qualifications of making decisions, documenting decisions, and explaining decisions to others; and experience interpreting federal and state regulations.

  08

  List any additional relevant experience you would like us to consider in determining if you meet the qualifications of this position. Please, include the months and years relevant to the experience you describe.

  Required Question

Agency

State of Colorado

Address

See the full announcement by clicking

the "Printer" icon located above the job title

Location varies by announcement, Colorado, --

Website

https://careers.colorado.gov/

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