Community Living Operations and Enrollment Analyst

State of Colorado•Denver, CO

6d•Hybrid

About The Position

The 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 looking for a Community Living Operations and Enrollment Analyst for the Office of Community Living! 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. The Office of Community Living exists as part of the Department of Health Care Policy and Financing, which is the federally recognized single state agency to administer the Colorado Medicaid program. The Office administers the state’s Long-Term Care (LTC) Services and Supports (LTSS) programs. The Office provides oversight and monitoring for the state’s system for access to LTSS programs. Staff within the Office are responsible for stakeholder relations, policy development and implementation, contract management and performance, program administration, operational support of case managers and direct services providers, and overall LTC Medicaid program performance.

Requirements

Seven (7) years of related professional experience interpreting regulations, analyzing data, implementing process improvements, and communicating policy and/or or system changes.
A bachelors degree from an accredited institution in Business Administration, Public Health, Public Policy, Social Services AND three (3) years of professional experience interpreting regulations, analyzing data, implementing process improvements, and communicating policy and/or or system changes.
Appropriate education will substitute for the required experience on a year-for-year basis.
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
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.

Nice To Haves

Prior experience working as a case manager supporting individuals in Home and Community Based Services (HCBS) to select providers.
Prior experience providing or validating business analysis and support for large Healthcare IT systems that facilitate Provider Enrollment, Prior Authorization (PAR) and medical claims processing, and/or Care and Case Management Systems.
Experience can extend to end users of these systems.
Prior experience working with medical provider enrollment and/or provider licensure.
Current or previous State experience.

Responsibilities

Provides leadership and oversight for provider enrollment operations related to Home and Community Based Services (HCBS), Money Follows the Person (MFP), and Community First Choice (CFC) programs.
Determines when provider and staff training materials require development or revision and leads training on the Medicaid Management Information System (MMIS) provider enrollment module.
Monitors provider enrollment progress, collaborates with the Colorado Department of Public Health and Environment to ensure effective enrollment processes, and directs claims data analysis related to credentialing concerns.
Oversees provider capacity-building initiatives by initiating scope change requests, manages biannual updates to the Provider Enrollment Grid to maintain compliance with regulatory and statutory requirements, and determines when enrollment changes necessitate updates to billing manuals, training materials, public-facing web content, and provider communications regarding system and enrollment changes.
Ensures all provider-submitted enrollment documents comply with relevant federal and state requirements.
Establishes the standards for, and subsequently develops, technical assistance materials for providers enrolling as Health First Colorado providers, working closely with Benefit and Case Management Division staff to ensure alignment with regulatory requirements for the HCBS waivers and other regulatory authorities.
Determines whether rule changes related to HCBS provider enrollment are needed, and manages all aspects of rule changes in concert with Benefits and Case Management Division staff responsible for waiver amendments and individual benefits.
Provides subject matter expertise to benefit managers responsible for the 1915(i) waiver documents that govern the Department’s services and supports all requests for information required to maintain federal compliance.
Initiates and manages process improvements to ensure efficient use of Department and provider resources.
Functions as Department lead on fraud referral and provider credentialing revocation.
Coordinates with the Department’s Program Integrity group and the Colorado Department of Public Health and Environment in the event there are issues with the validity of a provider’s enrollment information or if fraudulent billing activity is suspected.
Initiates and has oversight for, monthly meetings with the Colorado Department of Health and Environment to monitor and track the progress of HCBS providers enrolling as providers, as well as the status of providers under review or at risk for termination.
Leads the Department in developing strategies for provider capacity building, as well as determining when changes to the Medicaid Management Information System are needed to support effective and efficient provider enrollment activities, seeing all work through the Software Development Lifecycle (SDLC).
Manages project plans and tracking mechanisms necessary to see all projects through to completion.
Responsible for the development, maintenance, and deployment of internal-facing documentation regarding enrollment.
Directs the training of Benefits Division and Case Management Division staff as needed to support revalidation and enrollment work.
Cross trains other Systems Unit staff, including the Community Living Business and Operations Analyst.
Determines, and recommends to senior Office leadership, when additional staffing is needed for revalidation and enrollment activities.
Responsible for training and acting as a lead to these resources, overseeing their work as needed.
Leads initial and ongoing system training for Office staff, as they are the Office expert on the end-to-end enrollment and credentialing operations that are integrated into the Department’s IT systems.
Ensures that the system is operating in accordance with Office of Community Living business processes and statutory/regulatory requirements.
Leverages expertise to determine and initiate communication with the Health Information Office Care and Case Management Team and the Health Information Office Medicaid Management Information System (MMIS) Subject Matter Expert to ensure systems efficiency.
Leads participation in User Acceptance Testing as performed by Office staff relative to changes to the enrollment module, and the determination of how changes drive needed updates to billing manuals and external-facing web resources.
Provides initial claims research and troubleshooting for Office staff, helping to resolve issues quickly to provide optimal customer service to staff and end users of the system.
Responsible for managing system performance through the review and management of data points that identify potential problems.
Leads Office efforts related to the drafting of Scope Change Requests to initiate needed changes to the various systems and subsystems that interface with the Medicaid Management Information System.
Discerns when an issue is best resolved through process change or if systems changes are the only alternative.
Leads and manages all tracking of developed documents related to needed systems changes, ensuring that all impacted Office staff have been engaged and their feedback incorporated accordingly.
Provides prioritization recommendations to senior Office management about how best to prioritize resources and manage projects.
Leads project coordination across the Office once a system change has been prioritized by Department management, in close coordination with Health Information and Medicaid Operations Office staff, with efforts extending to requirements validation and testing.
Leads post-implementation monitoring to ensure base functionality and process performance is preserved, with work extending to monitoring provider feedback.

Benefits

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
Credit Union of Colorado Membership Eligibility
Some positions may qualify for the Public Service Loan Forgiveness Program.