Provider Compliance and Oversight Specialist TERM LIMITED

Provider Compliance And Oversight Specialist

The Department of Health Care Policy & Financing (HCPF) is seeking a Compliance Specialist to support financial oversight, contract management, and operational integrity within the Office of Community Living (OCL). This position plays a critical role in ensuring Home and Community-Based Services (HCBS) providers and vendors comply with state and federal regulations, departmental standards, and fiscal requirements.

Key Responsibilities

• Conduct financial compliance reviews of approximately 900 HCBS family caregivers and providers to ensure adherence to Department-established regulations, standards and service limitations.
• Review supporting documentation (e.g., payroll records, timesheets, pay stubs, and claims data) to assess compliance and identify overbilling or excess units.
• Calculate overpayments and determine compliance or non-compliance based on established thresholds.
• Communicate with impacted Medicaid provider agencies throughout the audit process via written correspondence and verbal engagement.
• Draft and issue notification letters, corrective action plans, closeout letters, and final findings in accordance with C.R.S. 25.5-4-301.
• Provide technical assistance and guidance to providers to resolve compliance issues and implement corrective actions.
• Maintain complete and accurate documentation of all reviews, communications, and outcomes in accordance with unit standards.
• Ensure all reviews align with Generally Accepted Government Auditing Standards (GAGAS) and Generally Accepted Accounting Principles (GAAP).
• Support appeals by preparing documentation and coordinating with leadership as needed.
• Aggregate and analyze data for internal and external reporting, including leadership, legislative, and federal reporting needs.
• Support management of complex vendor contracts within the Long-Term Care Utilization Review and Utilization Management (LTC UR/UM) program which may include reviewing deliverables, participate in procurement activities, and monitoring vendor performance.
• Conduct quality assurance reviews and process vendor invoices in compliance with State Fiscal Rules which may include reviewing invoices, tracking payments, and coordinating with internal teams.

Residency Requirement:

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

Minimum Qualifications

Compliance Specialist III (H1G3XX)

There are two ways to qualify for this position:

Option 1:

Six (6) total years of professional experience conducting compliance or fiscal reviews and/or working in Home and Community Based Services (HCBS).

Option 2

Bachelor's degree from an accredited institution in Health Care Administration, Public Health, Public Administration, Health Services, or a related field

AND

Two (2) total years of professional experience conducting compliance or fiscal reviews and/or working in Home and Community Based Services (HCBS).

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

• An associate's will count as two years of experience
• A bachelor's will count as four years of experience
• A master's 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, 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:

• Prior state experience in interpreting and applying state and federal regulations.
• Experience conducting financial compliance reviews/audits.
• Experience conducting programmatic compliance reviews/audits.
• Experience reviewing or submitting Health First Colorado claims.
• Experience using Microsoft Excel, SmartSheets, SalesForce, or other data Dashboards to conduct audits, create formulas for calculations, and/or general tracking.
• Experience managing government contracts.
• Experience participating in or supporting appeals, reconsiderations, or administrative review processes.
• Experience drafting professional written external communications related to compliance reviews or audits, such as audit notifications, corrective action letters, investigative findings, or compliance determinations.

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.
• This is a term-limited position with funding through June 30, 2028. Successful candidates will sign a Waiver of Retention Rights and normal personnel rules regarding retention will not apply. Additional information regarding term-limited positions can be found here.

APPEAL RIGHTS:

If you receive notice that you have been eliminated from consideration for this position, you may file an appeal with the State Personnel Board or request a review by the State Personnel Director.

An appeal or review must be submitted on the official appeal form, signed by you or your representative. This form must be delivered to the State Personnel Board by email (View email address on click.appcast.io), postmarked in US Mail or hand delivered (1525 Sherman Street, 4th Floor, Denver CO 80203), or faxed View phone number on click.appcast.io) within ten (10) calendar days from your receipt of notice or acknowledgement of the department's action.

For more information about the appeals process, the official appeal form, and how to deliver it to the State Personnel Board; go to spb.colorado.gov; contact the State Personnel Board for assistance at View phone number on click.appcast.io; or 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 under Rules.

How to Apply (PLEASE READ CAREFULLY)

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.

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 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.

ADAAA Accommodations: 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 is committed to the full inclusion of all qualified individuals. As part of this commitment, our agency will assist individuals who have a disability with any reasonable accommodation requests related to employment, including completing the application process, interviewing, completing any pre-employment testing, participating in

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