Community Living Operations and Enrollment Analyst

Community Living Operations and Enrollment Analyst We are looking for a Community Living Operations and Enrollment Analyst 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. The Office of Community Living exists as part of the Department of Health Care Policy and Financing, which is the federally recognized single state agency to administer the Colorado Medicaid program. The Office administers the state's Long‑Term Care (LTC) Services and Supports (LTSS) programs. The Office provides oversight and monitoring for the state's system for access to LTSS programs. Staff within the Office are responsible for stakeholder relations, policy development and implementation, contract management and performance, program administration, operational support of case managers and direct services providers, and overall LTC Medicaid program performance. Description of Job Position Summary Provides leadership and oversight for provider enrollment operations related to Home and Community Based Services (HCBS), Money Follows the Person (MFP), and Community First Choice (CFC) programs. Determines when provider and staff training materials require development or revision and leads training on the Medicaid Management Information System (MMIS) provider enrollment module. Monitors provider enrollment progress, collaborates with the Colorado Department of Public Health and Environment to ensure effective enrollment processes, and directs claims data analysis related to credentialing concerns. Oversees provider capacity‑building initiatives by initiating scope change requests, manages biannual updates to the Provider Enrollment Grid to maintain compliance with regulatory and statutory requirements, and determines when enrollment changes necessitate updates to billing manuals, training materials, public‑facing web content, and provider communications regarding system and enrollment changes. Key Responsibilities This position exists as the Department staff authority on initial and ongoing enrollment and revalidation of Health First Colorado HCBS, CFC, and MFP Providers and Case Management Agencies that support eligible Medicaid and State General Fund participants. Ensures all provider‑submitted enrollment documents comply with relevant federal and state requirements. The position establishes the standards for, and subsequently develops, technical assistance materials for providers enrolling as Health First Colorado providers, working closely with Benefit and Case Management Division staff to ensure alignment with regulatory requirements for the HCBS waivers and other regulatory authorities. As the Department staff authority on HCBS, CFC, MFP, and Case Management provider credentialing, the role determines whether rule changes related to HCBS provider enrollment are needed, and manages all aspects of rule changes in concert with Benefits and Case Management Division staff responsible for waiver amendments and individual benefits. Role also provides subject matter expertise to benefit managers responsible for the 1915(i) waiver documents that govern the Department's services and supports all requests for information required to maintain federal compliance. Initiates and manages process improvements to ensure efficient use of Department and provider resources. Role also functions as Department lead on fraud referral and provider credentialing revocation. Work extends to coordination with the Department's Program Integrity group and the Colorado Department of Public Health and Environment in the event there are issues with the validity of a provider's enrollment information or if fraudulent billing activity is suspected. In working with the Colorado Department of Public Health and Environment, role initiates and has oversight for, monthly meetings with the Colorado Department of Health and Environment to monitor and track the progress of HCBS providers enrolling as providers, as well as the status of providers under review or at risk for termination. Leveraging data from enrollment information and claims data, the position leads the Department in developing strategies for provider capacity building, as well as determining when changes to the Medicaid Management Information System are needed to support effective and efficient provider enrollment activities, seeing all work through the Software Development Lifecycle (SDLC). Manages project plans and tracking mechanisms necessary to see all projects through to completion. Role is responsible for the development, maintenance, and deployment of internal‑facing documentation regarding enrollment. Role directs the training of Benefits Division and Case Management Division staff as needed to support revalidation and enrollment work. Responsibilities extend to cross training other Systems Unit staff, including the Community Living Business and Operations Analyst. Role also determines, and recommends to senior Office leadership, when additional staffing is needed for revalidation and enrollment activities. Role is responsible for training and acting as a lead to these resources, overseeing their work as needed. Position leads initial and ongoing system training for Office staff, as they are the Office expert on the end‑to‑end enrollment and credentialing operations that are integrated into the Department's IT systems. Role's expertise ensures that the system is operating in accordance with Office of Community Living business processes and statutory/regulatory requirements. Role leverages expertise to determine and initiate communication with the Health Information Office Care and Case Management Team and the Health Information Office Medicaid Management Information System (MMIS) Subject Matter Expert to ensure systems efficiency. Role leads participation in User Acceptance Testing as performed by Office staff relative to changes to the enrollment module, and the determination of how changes drive needed updates to billing manuals and external‑facing web resources. Role provides initial claims research and troubleshooting for Office staff, helping to resolve issues quickly to provide optimal customer service to staff and end users of the system. Role responsible for managing system performance through the review and management of data points that identify potential problems. Position leads Office efforts related to the drafting of Scope Change Requests to initiate needed changes to the various systems and subsystems that interface with the Medicaid Management Information System. Position discerns when an issue is best resolved through process change or if systems changes are the only alternative. Role leads and manages all tracking of developed documents related to needed systems changes, ensuring that all impacted Office staff have been engaged and their feedback incorporated accordingly. Work extends to the provision of prioritization recommendations to senior Office management about how best to prioritize resources and manage projects. Role leads project coordination across the Office once a system change has been prioritized by Department management, in close coordination with Health Information and Medicaid Operations Office staff, with efforts extending to requirements validation and testing. Position leads post‑implementation monitoring to ensure base functionality and process performance is preserved, with work extending to monitoring provider feedback. Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights

MINIMUM QUALIFICATIONS:

Analyst IV H1C4XX There are two ways to qualify for this position: Option 1: Experience Only: Seven (7) years of related professional experience interpreting regulations, analyzing data, implementing process improvements, and communicating policy and/or system changes. Option 2: Education and Experience: A bachelor's degree from an accredited institution in Business Administration, Public Health, Public Policy, Social Services AND three (3) years of professional experience interpreting regulations, analyzing data, implementing process improvements, and communicating policy and/or system changes. 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 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 experience working as a case manager supporting individuals in Home and Community Based Services (HCBS) to select providers. Prior experience providing or validating business analysis and support for large Healthcare IT systems that facilitate Provider Enrollment, Prior Authorization (PAR) and medical claims processing, and/or Care and Case Management Systems. Experience can extend to end users of these systems. Prior experience working with medical provider enrollment and/or provider licensure. Current or previous State 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 disciplinarily terminated, resigned in lieu of disciplinary termination, or negotiated their termination from the State of Colorado must disclose this information on the application. #J-18808-Ljbffr Colorado Department of Transportation