Pediatric Behavioral Therapy (PBT) Policy Specialist

Pediatric Behavioral Therapy Policy Specialist

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 Pediatric Behavioral Therapy (PBT) Policy Specialist for the Policy & Benefits Delivery Systems Division of the Health Policy Office (HPO)!

The Policy and Benefits Delivery Systems Division of HPO 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.

We are committed to increasing the diversity of our staff and providing culturally responsive programs and services. Therefore, we encourage responses from people of diverse backgrounds and abilities.

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
• Reduced college tuition through CSU Global
• Credit Union of Colorado Membership Eligibility
• Some positions may qualify for the Public Service Loan Forgiveness Program. For more information, go to

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.

**Please note - equipment provisioning and certain onboarding tasks will take place in person, in our downtown Denver office, on the first day of employment.**

What You'll Be Doing as PBT Policy Specialist:

• Serve as the Department's recognized Staff Authority on all matters related to the PBT benefit by researching, interpreting, developing, and recommending policy solutions concerning complex clinical, operational, regulatory, reimbursement, and programmatic issues.
• Directly influence Department-wide policy development, benefit administration, claims processing, provider communications, system configuration, program implementation, budget planning, and compliance activities.
• Provide authoritative guidance to executive leadership, program areas, fiscal staff, legal counsel, contractors, providers, advocacy organizations, and other internal and external stakeholders regarding PBT policy and program requirements.
• Provide strategic leadership, management, and oversight of the Pediatric Behavioral Therapy (PBT) benefit, ensuring claims processing, prior authorization requirements, provider guidance, and program operations comply with approved Medicaid policy, State Plan requirements, federal regulations, and the Colorado Code of Regulations.
• Lead complex projects and initiatives to define, evaluate, and modify the amount, scope, and duration of the PBT benefit to promote member access, quality outcomes, regulatory compliance, and cost-effective service delivery.
• Develop and maintain State Plan language and drafting State Plan Amendments, regulations, fiscal analyses, legislative analyses, provider billing guidance, and implementation plans related to the PBT benefit.
• Collaborate across divisions and with external partners to establish reimbursement methodologies, implement policy and operational changes, evaluate program performance, resolve complex policy issues, and ensure the effective administration of the PBT benefit statewide.

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:

H1R4XX - POLICY ADVISOR IV

Minimum Qualifications:

There are two ways to qualify for this position:

Option 1:

Seven (7) total years of professional experience in behavioral health (including ABA service delivery, private practice, and/or work within a health plan or insurance setting).

Option 2:

Bachelor's degree from an accredited institution in behavioral health or a related field of study AND

Three (3) total years of professional experience in behavioral health (including ABA service delivery, private practice, and/or work within a health plan or insurance setting).

Appropriate education will substitute for the required experience on a year-for-year basis. Relevant education will be calculated as the following:

• An associates 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

Note: Per the Job Application Fairness Act (Download PDF reader), you may redact information that identifies your age, date of birth, or dates of attendance at or graduation from an educational institution on your transcripts.

PREFERRED QUALIFICATIONS

• Previous relevant professional state experience
• Masters degree in a social sciences field
• Behavioral Therapy credential (BCBA or equivalent)
• Professional experience in:
• Clinical behavioral health
• Health care policy development/oversight
• Claims processing, prior authorization processes, and/or utilization reviews
• Health care benefit/program administration or operations
• Implementing quality improvement initiatives

Skills to Support Success

• Proficiency using Microsoft Office Suite and Google Applications.
• Ability to actively listen, interpret verbal cues, and articulate complex information across various audiences.
• Capacity to manage stressful situations, embrace change, and recover from setbacks.
• Ability to build interpersonal relationships, work effectively with key stakeholders, align shared goals, and minimize team friction.
• Application of intellectual curiosity to evaluate procedures logically and solve work-related problems.
• Ability to speak and write authoritatively and compellingly, resolve communication problems, and manage competing interests.
• Ability to adapt behavior and work methods in response to new information, changing conditions, or unexpected obstacles.

Definition of Professional Experience: Work that involves exercising discretion, analytical skill, judgment, 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.

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: