Commercial Products Analyst I - Denver Health Medical Plan (Must Live in Colorado. Weekly On Site Requirement.)

Denver Health and Hospital Authority•Denver, CO

5d•Hybrid

About The Position

We are recruiting for a mission-driven Commercial Products Analyst I - Denver Health Medical Plan to join our team! We're with you for life’s journey. At Denver Health, purpose isn’t just something we believe in—it’s something we live every day, for life’s journey. Our Values Respect | Belonging | Accountability | Transparency. This is a hybrid role located in Denver, Colorado with a requirement of being in the office 2 days per week. The Analyst, under general supervision, assists in developing Denver Health Medical Plan, Inc. (DHMP) Health Plan Products to ensure compliance with all Federal and State–level regulatory requirements. This position requires strong attention to detail and the ability to independently research, interpret, and apply regulatory guidance to support compliance activities and business operations. The Analyst leads and provides expert technical assistance to highly visible, sensitive, and multifaceted compliance initiatives. Assists in setting strategic direction of projects, developing project plans, analytic support services and technical expertise to a broad array of issues. Prepares monthly reports, develops marketing materials, policies, and procedures for each line of business. This position will interact with all levels of management and employees, plan members, external consultants and Federal and State representatives. The Analyst works collaboratively, fosters and promotes dialogue with CMS Regional Office, State Agencies, and Community Partners.

Requirements

Bachelor's Degree required
1-3 years direct health care experience with a specific emphasis on government health program operations, commercial health plan operations, regulatory issues, policy development, or compliance required
Extensive knowledge of managed care/health care administration, policy and compliance.
Proven ability to interpret and synthesize Federal and State regulatory requirements, ensuring policies, procedures and processes are updated to comply with guidelines.
Ability to develop data requirements and work with operations teams and groups to extract, organize and analyze data and trends.
Ability to define problems, collect data, establish facts and draw valid conclusions to implement solutions.
Demonstrates ability to manage multifaceted projects in conjunction with day-to-day activities.
Excellent interpersonal and customer service skills, ability to work collaboratively with other corporate groups (such as Compliance Department, and Information Systems), external vendors and State and Federal entities.
Self-motivated and takes initiative: identifies, acts on, and documents solutions for gaps and opportunities for process improvements.
Critical thinking, strong written and verbal communication skills, and the ability to effectively interact within a team.
Assists in monitoring of risk assessments, preparation and compilation of audit requirements interprets audit results; monitors daily, weekly and monthly reports.
Proficiency in Health Plan Management Software involving Claims, Enrollment systems, and Government Data Portals.
Knowledge of PC applications, specifically Microsoft Office products, and the ability to learn computer applications.
Must live in Colorado

Responsibilities

Compiles, analyses and ensures the accuracy of data and documentation for internal and external compliance audits.
Creates and monitors marketing materials and content to meet State and Federal regulatory requirements, including member handbooks/Explanation of Coverage, notifications regarding enrollment, beneficiary rights and protections, and other mandated communications.
Assists in setting strategic direction of projects, developing project plans, analytic support services and technical expertise to a broad array of issues.
Develops and drafts policies and procedures in alignment with State and Federal Requirements, ensures operationalization of policies and procedures. Identifies problems and opportunities for improvement; works collaboratively to identify solutions.
Compiles reports, attestations, and other submissions to submit to the State and Federal agencies. Reconciles complex sets of data received from State and Federal Regulators in order to validate reporting, financial reconciliation, and encounter submissions to align with established goals and metrics.
Monitors external vendors or first tier entities that administer benefits for members, analyzing data to ensure compliance with contractual requirements.
Serves as Liaison between Product Lines and other areas of the Managed Care Department, to interpret contractual and regulatory requirements that may assist with provider, member or other operational concerns.

Benefits

Generous paid time off, starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays
100% paid parental leave up to 6 weeks
Immediate eligibility for retirement plans with employer contribution up to 9.5%
Generous medical, dental, vision plans in addition to employer paid disability and life insurance.
Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center
Free RTD EcoPass (public transportation)
Childcare discount programs & exclusive perks on large brands, travel, and more
Tuition reimbursement & assistance
Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways
Professional clinical advancement program & shared governance
Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer