Provider Compliance and Oversight Specialist TERM LIMITED

Provider Compliance and Oversight Specialist

We are looking for a Provider Compliance and Oversight Specialist for the Office of Community Living!

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.**

Description of Job

Position Summary

The Colorado 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.

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.

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).

Education and Experience:

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.