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Managed Care Rates & Reconciliation Analyst
Managed Care Rates & Reconciliation AnalystGovernment Jobs • Denver, CO, US
Managed Care Rates & Reconciliation Analyst

Managed Care Rates & Reconciliation Analyst

Government Jobs • Denver, CO, US
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Managed Care Rate & Reconciliation Analyst

We are looking for a Managed Care Rate & Reconciliation Analyst to join our Managed Care Rates HMO Rates Unit!

As part of the State of Colorado, HCPF offers a competitive benefits package :

  • 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

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.

Description of Job

What you'll be doing : Position supports the capitation rate development for the Health Maintenance Organizations (HMOs), Children Health Plan Plus (CHP+) and Program for All-Inclusive Care for the Elderly (PACE) program with the following responsibilities :

  • This position uses database software to extract, compile and interpret data.
  • Develops and completes a range of analyses and reports using statistical measures or under instruction from other senior analysts.
  • Reviews the federal and state regulation changes to ensure the HMOs, CHP+, and PACE program comply with any relevant changes.
  • Collaborates and coordinates different projects in other areas (such as accounting, budget, interchange system, program policy team and others) in the Department to ensure the program operations run smoothly.
  • Performs quality reviews and provides statistical analysis support for all the programs.
  • Reviews financial data submitted by the managed care entities, determines its validity and correctness, and makes recommendations regarding any necessary wrap around payments and capitation reconciliations.
  • Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights

    Residency Requirement : This posting is only open to residents of the State of Colorado at the time of submitting your application.

    Class Code & Classification Description : RATE OR FINANCIAL ANALYST II

    Minimum Qualifications :

  • Experience Only : Six (6) years of relevant experience in State and Federal managed care policies, Budgeting, Data analysis, Data manipulation using Excel
  • OR
  • Education and Experience : Bachelors in Economics, Mathematics, Statistics, Data Science, Finance, Public Health, or other related AND Two (2) years of experience in State and Federal managed care policies, Budgeting, Data analysis, Data manipulation using Excel
  • Appropriate education will substitute for the required experience on a year-for-year basis. Relevant education will be calculated as the following :

  • 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
  • Preferred Qualifications & Special Qualifications :

  • Master's degree
  • Intermediate SQL or other database experience
  • Intermediate to expert level in Excel
  • Experience in Tableau, SAS, or other statistical and visualization packages
  • Experience interpreting State and Federal regulations
  • Managed Care experience
  • 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.
  • Appeal Rights :

    An applicant who has been removed from an employment list or removed from consideration during the selection process may request a review by the State Personnel Director.

    As an applicant directly affected by the results of the selection or comparative analysis process, you may file a written appeal with the State Personnel Director.

    Review of the completed, signed and submitted appeal will be timely on the basis of written material submitted by you, using the official appeal form signed by you or your representative. This form must be completed and delivered to the State Personnel Board by email at dpa_state.personnelboard@state.co.us within ten (10) calendar days from your receipt of notice or acknowledgement of the Department's action.

    For further information on the Board Rules, you can refer to 4 Colorado Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, at spb.colorado.gov / board-rules.

    Supplemental Information

    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 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. 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 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 will result in your application being rejected. 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 Health Care Policy & Financing does not offer sponsored visas for employment purposes.

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