HOSPITAL POLICY SPECIALIST

State of Colorado Job Opportunities - Denver, CO3.5

30+ days agoFull-time
Department Information

STATE OF COLORADO RESIDENCY REQUIRED

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

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". For more information visit: http://www.colorado.gov/hcpf.

The Health Programs Benefits and Services Division is responsible for the administration and performance of Medicaid acute care services and programs. The services and programs include both physical health and behavioral health. Staff within the Division are responsible for stakeholder relations, policy development and implementation, contract management and performance, program administration and overall Medicaid program performance. The Division plays an important role in working toward the Department of Health Care Policy and Financing's (Department) mission to improve access to cost-effective, quality health care services for Coloradans.

Description of Job
What You'll be Doing

Position co-manages the day-to-day operations of the Inpatient and Outpatient Hospital Services benefits. These benefits include, but are not limited to: inpatient and outpatient hospital, laboratory and genetic testing services, and single case agreements. Position researches and recommends best practices based on gathered input and existing evidenced-based guidelines to manage, identify and address benefit or policy gaps, respond to provider inquiries about benefit limitations and policy, and assess current and future benefit policies to meet the Department's expectations for efficient, cost-effective, quality care of clients.

Position develops productive working relationships and collaborates with stakeholder groups and individuals to constructively address disagreements and policy challenges that are critical to the success of the benefit. Position works with other sections to ensure all inpatient and outpatient hospital services are included in managed care contracts and known to the Regional Accountable Entity within the Accountable Care Collaborative; provides recommendations to other benefit and/or programs managers on ways to define and implement inpatient and outpatient hospital services for new programs or populations, and/or helps align current programs with the coverage policies of the inpatient and outpatient hospital services. Position serves as a liaison between the Department's various stakeholders, such as professional associations, providers, clients, advocates, sister state agencies, and lobbyists.

Position works with other sections to identify and establish metrics and/or benchmarks to monitor policy changes, track and monitor utilization and expenditures, provide or participate in quality improvement reviews, assist with the operation of diagnosis-related groups (DRGs) and medical coding (diagnosis and procedural) policies, assist with the development of the enhanced ambulatory payment groupers (EAPG), and identify ways to enforce policy changes through claims system edits or prior authorization request requirements/criteria. Position identifies issues that require additional clarification, and drafts necessary Provider Bulletin articles and makes necessary updates and revisions to respective billing manuals.

Position maintains knowledge and familiarity of Colorado Medicaid legal requirements by researching and analyzing the pertinent State and Federal laws and regulations and the Colorado Medicaid State Plan to identify areas where the inpatient and outpatient hospital, laboratory and genetic testing services, and single case agreements, State Plan, or Colorado Code of Regulations may need to be amended

Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights
Minimum Qualifications
Education: Graduation from an accredited college or university with a bachelor's degree in public health, public policy, business administration, health care administration, health care information technology or in a field of study related to the work assignment;
AND
Experience: Two (2) years of professional experience in health policy and/or operations.

Substitutions
A combination of work experience in the occupational field or specialized subject area of the work assigned to the job, which provided the same kind, amount, and level of knowledge acquired in the required education, may be substituted on a year-for-year basis for the bachelor's degree. A master's or doctorate degree from an accredited college or university in public health, public policy, and health care administration may be substituted for the bachelor's degree and one year of general experience.

DEFINITION OF PROFESSIONAL EXPERIENCE: Work that involves exercising discretion, analytical skill, judgment, and 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.

Preferred Qualifications

Effective communication (verbal and written) and interpersonal skills
Exceptional attention to detail
Current knowledge of Medicaid and health care industry, rules, and regulations
Expert knowledge of Inpatient and Outpatient Hospital Services benefits to include Telemedicine services, and benefit and program policies
Working experience of MMIS, Cognos, and other data systems

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.
Valid State of Colorado Drivers License

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 by the closing date of this announcement will result in your application being rejected.

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 IS AN EQUAL OPPORTUNITY EMPLOYER~

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).