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Audit Specialist - Denver, CO #7666326

Company: State of Colorado

Date: 10/17/2020

City: Denver, CO

Employment type: Full-time

Department Information


Medicaid Operations Office


Make a difference-Join HCPF by improving health care access and outcomes for the people we serve while demonstrating stewardship of financial resources.


Information about the Department:


This announcement will remain open until advertised or until 100 applications have been received; whichever occurs first. Eligible applicants are encouraged to apply early.


The Department of Health Care Policy and Financing (Department) offers a competitive benefits package to include the Public Employees Retirement Account (PERA), 401k/457, health/dental insurance options, 10 holidays, accrual of paid sick and vacation/annual time, flex place and flex time. The Department is also centrally located; offers affordable ECO passes; has a fitness center on-site; and a variety of discounts on services and products are available to state employees through the State of Colorado's Work-Life Employment Discount Program. The Department also encourages employees to take advantage of advanced education and offers reduced college tuition through CSU Global for their employees. This Department is a "Tobacco Free Workplace". www.colorado.gov/hcpf


The Medicaid Operations Office oversees health plan operations administered by the Department. This office is responsible for the overall operations of Medicaid, including Child Health Plan Plus (CHP+). This office manages the daily operations of Medicaid to ensure compliance with Federal and State laws, rules and regulations. In addition, this office is responsible for establishing and monitoring the operational performance standards (e.g., call center performance standards, claims payment standards, enrollment processing standard, etc.) for contractors working for the Department. This office establishes systems for robust monitoring of health plan operations, oversees the collection of information necessary for performance monitoring and directs staff reviews to identify and mitigate compliance risks. This office has oversight of claims payment operations, the member and provider call centers; the member identification card contractor; and eligibility determinations made by eligibility sites and monitoring of county partners.


Description of Job


Position supports the Audits Research Section by working with all internal and external auditors to research and respond to eligibility audit exceptions and findings. Position issues opinions in the interpretation of regulations, rules, concepts and theories as they apply to medical eligibility determinations and CBMS processing. Position reviews audit findings, researches information contained in case files and CBMS in comparison to the rules, regulations and statutes, determines correctness of findings. Position is expected to make decisions that involve deciding what operation is required to carry out the task assigned and determine how the operation will be completed. Position is expected to use independent judgement to solve most problems when presented. Position communicates and coordinates eligibility audit findings and exceptions to Section Lead, Supervisor and Manager, and supports the implementation of recommendations. Position provides Department management with regular updates on projects related to eligibility determinations and projects and explains the impact on clients and eligibility sites. Position is expected to operate independently and apply existing guidelines to solve problems.


Position serves as a direct resource for Medical eligibility sites which includes reviewing Medical eligibility sites performance through audit findings and recommendations; appeals; complaints; data; and reporting. Position is responsible for communicating changes through conducting formalized training, drafting written guidance and participating in conferences and workgroups. Position also can process applications as a result of special requests made of the Department. This position contributes to the Eligibility Site Accountability and Oversight Program. This position is responsible for researching and responding to errors found in the eligibility site accuracy reviews. Position provides guidance and recommendations to increase effectiveness or to ensure compliance.


Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights


MINIMUM QUALIFICATIONS:


Education and Experience:


Graduation from an accredited college or university with a bachelor's degree in business administration, public administration, health care administration, or a field of study closely related to the work assignment AND two (2) years of professional experience processing, troubleshooting, navigating, conducting research, and auditing medical assistance applications based on state and federal rules, regulations and statues in the State's Medicaid eligibility system, CBMS and PEAK


.


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:



  • Professional experience working with researching, reviewing, understanding and interpreting complex federal and state regulations for public assistance programs in CBMS and/or PEAK;
  • Knowledge of how to gather and document business requirements and use cases;
  • Professional experience documenting functional requirements for public assistance programs in CBMS and/or PEAK related systems, policy or training issue;
  • Knowledge of how to gather and analyze data and produce reports based on the findings;
  • Exceptional writing and proofreading skills;
  • Demonstrated ability to meet hard deadlines, work with minimal supervision and maintain a focus on priorities in an environment of constant change
  • Ability to set and prioritize workload, develop a work plan with tasks, time frames, milestones, resources, and dependencies;
  • Strong communication skills, verbal and written; and
  • Ability to be self-motivated and self-directed, while possessing the ability to work in a team environment.

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 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:


If you receive notice that you have been eliminated from consideration for the position, you may protest the action by filing an appeal with the State Personnel Board/State Personnel Director within 10 days from the date you receive notice of the elimination.


Also, if you wish to challenge the selection and comparative analysis process, you may file an appeal with the State Personnel Board/State Personnel Director within 10 days from the receipt of notice or knowledge of the action you are challenging.


Refer to Chapters 4 and 8 of the State Personnel Board Rules and Personnel Director's Administrative Procedures, 4 CCR 801, for more information about the appeals process. The State Personnel Board Rules and Personnel Director's Administrative Procedures are available at www.colorado.gov/spb.


A standard appeal form is available at: www.colorado.gov/spb. If you appeal, your appeal must be submitted in writing on the official appeal form, signed by you or your representative, and received at the following address within 10 days of your receipt of notice or knowledge of the action: Colorado State Personnel Board/State Personnel Director, Attn: Appeals Processing, 1525 Sherman Street, 4th Floor, Denver, CO 80203. Fax: 303-866-5038. Phone: 303-866-3300. The ten-day deadline and these appeal procedures also apply to all charges of discrimination. Supplemental Information


How to Apply (PLEASE READ CAREFULLY)


Applicants are encouraged to attach a cover letter and resume to their application.


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 of 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 up to 6 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 and information by the closing date of this announcement will result in your application being rejected.


~THE STATE OF COLORADO IS AN EQUAL OPPORTUNITY EMPLOYER~


ADAAA Accommodations: Any person with a disability as defined by the ADA Amendments Act of 2008 (ADAAA) may be provided a reasonable accommodation upon request to enable the person to complete an employment assessment. To request an accommodation, please contact by phone or email at least five business days before the assessment date to allow us to evaluate your request and prepare for the accommodation. You may be asked to provide additional information, including medical documentation, regarding functional limitations and type of accommodation needed. Please ensure that you have this information available well in advance of the assessment date.


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 Healthcare Policy and 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, Debra Becerra at debra.becerra@state.co.us or call 303-866-3887.


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.


Technical Help


If you experience difficulty in uploading or attaching documents to your online application, call NEOGOV technical support at 877-204-4442 anytime between 6:00 a.m.-6:00 p.m. (Pacific Time).




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