Compliance Specialist

Compliance Specialist

Envision yourself working at HCPF. 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.

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. For more information, go to .

We are looking for a Compliance Specialist to join the Fiscal Agent Operations Unit! The Fiscal Agent Operations unit is responsible for overseeing the day-to-day operational functions that support the administration of Colorado's Medicaid and Child Health Plan Plus (CHP+) programs. A core component of this work includes supporting all provider activities, such as provider enrollment, claim submission, communications, call center operations, and training. By maintaining these functions, the unit ensures providers receive accurate information, timely assistance, and streamlined access to participate in the program.

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 Compliance Specialist

• Conducts external audits of vendor processes, procedures, and systems to evaluate compliance with applicable state and federal laws, regulations, and policies.
• Researches regulatory and policy requirements to ensure vendor operations and deliverables meet compliance standards. Prepares detailed written reports summarizing audit results, identifying deficiencies, and recommending corrective actions and process improvements.
• Collaborates with vendor staff to review findings and support implementation of corrective actions.
• Performs audits of internal processes and procedures to ensure compliance with applicable laws, regulations, and policies.
• Reviews and evaluates internal controls, identifying gaps or risks, and recommends improvements to strengthen compliance and operational effectiveness.
• Coordinates and responds to requests for information from external entities, including law enforcement agencies and other oversight bodies, ensuring compliance with applicable laws and requirements such as the Colorado Open Records Act (CORA).
• Intakes, organizes, and tracks requests to ensure timely and accurate responses in accordance with established procedures.
• Collaborates with internal units, departments, and vendors to gather necessary information and ensure responses are complete, compliant, and well-documented.
• Performs special projects and other duties as assigned to support operational needs of the unit.

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:

H1G3XX - COMPLIANCE SPECIALIST III

MINIMUM QUALIFICATIONS:

There are two ways to qualify for this position:

Option 1:

Six (6) years of professional experience conducting audits, compliance reviews, or program evaluations, including interpreting and applying federal and/or state regulations.

OR

Option 2: Education and Experience:

A bachelor's degree from an accredited institution in Business Administration, Finance, Law, Healthcare Administration, or a related field; AND two (2) years of professional experience conducting audits, compliance reviews, or program evaluations, including interpreting and applying federal and/or state regulations.

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:

• Prior state experience related to the duties of this position.
• Prior experience working with Medicaid, CHP+, or other public healthcare programs, including knowledge of provider operations, claims, or program integrity requirements.
• Prior experience applying formal audit or internal control frameworks (e.g., GAO, COSO, or similar), including developing risk-based audit approaches and evaluating internal controls.

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 :

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 View email address on click.appcast.io 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.