Medicaid Eligibility Quality Control (MEQC) Reviewer Salary $4,515.00 - $6,607.00 Monthly Location Denver Metro, CO Job Type Full Time Department Department of Health Care Policy and Financing Job Number UHA 03391 10/25/18 Closing 11/8/2018 11:59 PM Mountain Department Information Finance Office Audit and Compliance Division Eligibility and Claims Review Section Must be a resident of Colorado to apply! 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: 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". Finance Office: The Finance Office consists of the Chief Financial Officer, the Budget Division, Controller Division, Payment Reform Section, Special Financing Division, Audits and Compliance Division, and Strategy Section. The Chief Financial Officer (CFO) is accountable for the financial and risk management operations of the Department, and oversees control systems that report financial results and maintain Department compliance. The CFO is responsible for the Department's financial data and reporting, and its use of data analytics to define value and measure quality with regard to Department operations. The CFO develops the Department's financial and operational strategy, and generates actionable analytics tied to that strategy. Claims Investigation Unit (CIU): The CIU reviewers conduct program integrity reviews and preliminary investigations of fraud. Medicaid Eligibility Quality Control (MEQC) Program: The MEQC program assesses eligibility determinations to assure accuracy and timeliness of the eligibility determination. This is done to avoid inappropriate payments and client determination delays. This program is required by the federal government. Eligibility Data Analytics (EDA) The EDA uses analytic tools to report on large-scale eligibility issues and supports audits with data requests and analysis. Description of Job Position audits Medical Assistance eligibility determinations to ensure the determination was made in accordance with federal and state regulations, rules, and procedures Collaborates with other MEQC team members to determine and develop audit methodology, performance measures, procedures and audit proposals per federal and state regulations and guidance Identifies errors and the specific cause of the errors by researching and applying appropriate federal and state rules and policies and procedures Ensures error findings are accurate and supported by rules and procedures. Works closely with other MEQC team members to ensure consistency and accuracy Communicates error findings to Department staff and eligibility site administrators. Position responds to Department and eligibility site rebuttals Develops comprehensive audit finding reports with proposed recommendations to address the findings discovered in the audit. Requests and reviews quality improvement plan on audit findings. Position tracks and follows up on the implementation status of the quality improvement plan Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights Minimum Qualifications Education: Graduation from an accredited college or university with a bachelor's degree in Business Administration, Communication, Public Health, Public Policy, and Sociology or in a field of study related to the work assignment AND Experience: Two (2) years of professional experience include: Researching and interpreting complex state and federal rules OR Ensuring program compliance per federal and state regulations AND Detailed orientated, self-motivated, self-directed with the ability to work in a team environment and work with short deadlines . Substitutions A combination of work experience in , auditing, conducting research of state, federal rules, regulations and statutes, public policy development and implementation or public health program administration, 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 Business Administration, Communications, Public Health Administration, Public Policy, or Sociology may be substituted for the bachelor's degree and one year of professional experience. Your experience must be substantiated within the Work Experience section of your application. Your resume will not be reviewed to determine if you meet the minimum qualifications; only the work experience section of your application will be reviewed to determine this. "See Resume" statements on the application will not be accepted. In addition, part-time work will be prorated. A copy of your college/university transcript must be submitted at the time of application (Unofficial transcripts are acceptable.) 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: Researching and interpreting complex state and federal rules AND Ensuring program compliance per federal and state regulations Proven ability to manage multiple projects and implement process improvements Possesses excellent organizational, problem solving, planning and reporting skills Excellent verbal and written communication skills Self-motivated, self-directed with the ability to work in a team environment and work with short deadlines Flexible, adaptable, and deadline-oriented 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. Position must travel with occasional overnight stays, therefore; overnight availability and a valid Colorado Driver's License is required. 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. ~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). 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: 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 positions at HCPF are security sensitive positions and require that potential employees undergo a criminal record background check. As a condition of employment, you are 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 and Financing? If so, please list their name. Yes No 03 This position requires some travel. Do you currently possess a valid Colorado Driver's license? Yes No 04 Please describe in detail your experience in researching and interpreting federal and state regulations and rules 05 Do you have experience managing several projects at one time? If yes, please provide information on how you prioritized and accomplished your work. 06 Please detail a time you implemented a process improvement at work. Describe the steps you took to implement this. 07 Do you have at least 2 years of professional experience in the following? Please check the boxes that apply. Ensuring program compliance per federal and state regulations and rules Researching and interpreting complex state and federal rules and regulations 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