Medical Coding and Fiscal System Administrator at State of Colorado – Denver, Colorado

STATE OF COLORADO RESIDENCY REQUIRED AT TIME OF APPLICATION

NOTE: This announcement may be used to fill multiple openings.

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.

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.

We are looking for a Medical Coding and Fiscal System Administrator to join our Clinical Operations Division team!

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 https://www.colorado.gov/pacific/dhr/student-loan-forgiveness-programs. https://dhr.colorado.gov/dhr-resources/student-loan-forgiveness-programs

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 fully remote, hybrid, to full-time in the office. Specific discussions about the schedule will be discussed during the offer stage.

What you will be doing:

• Serves as the Staff Authority for medical coding processes to support the mission of the Department.
• Identifies operational, system and coding changes needed to support policy changes for medical programs including those made by legislature.
• Designs and implements correct coding edits in the fiscal system on a monthly basis to decrease Medicaid fraud and abuse due to inappropriate billing practices.
• Analyzes complex data and report design to support the rules and goals of Medicaid and the needs of Medicaid staff and the Department.
• Prepares accurate and detailed requirement specifications related to medical coding and claims processing.
• Collects, analyzes and evaluates information to determine the operational efficacy and workflows related to medical coding. Directs management on solutions based upon research of trends, technology paths, process management and system (fiscal and UM systems) requirements.
• Implements coding processes and systems that are mission-critical and directly impact the Department’s ongoing operation and success.
• Evaluates information gathered from multiple sources, reconciles conflicts, extracts both high- and low-level information to develop a general understanding of user requests and simultaneously engages in multiple initiatives.
• Analyzes information needs and functional requirements to manage change requests related to the necessary fiscal and UM systems.
• Establishes the technical changes in the fiscal reference subsystem by adding and updating information in the procedure code file, diagnosis code file, revenue code file, provider rate file, procedure/modifier table, systems lists, edits and audits to ensure appropriate Medicaid claims payment.
• Provides medical coding direction and resolves complicated medical coding issues and questions for the Department, the Department’s fiscal agent, the Department’s acute care utilization reviewer, the Colorado Department of Human Services (DHS) and providers.
• Drafts extensive (100+ pages) bulletins to inform providers of annual Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) procedure code updates, benefit limitations, reimbursement rates and prior authorization requirements.

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: (New)

H1B4XX

ADMINISTRATOR IV

MINIMUM QUALIFICATIONS:

There are two ways to qualify for this position:

Option 1:
Seven (7) years of experience in healthcare billing and medical coding (hospital, facility, clinic, healthcare insurance company, etc.)

OR

Option 2:

Education and Experience:

A four year college degree in Health Information Management, Health Sciences, Health Management, or Healthcare Administration

AND

Three years of experience in healthcare billing and medical coding (hospital, facility, clinic, healthcare insurance company, etc.)

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 & Special Qualifications:

• 2-3 years leading new coding guidelines/programs and coding processes/workflows in a (hospital, facility, clinic, healthcare insurance company, etc.)

• Professional working experience for a healthcare insurance provider or healthcare coverage program

• Experience working within a Medicaid Enterprise computer system

• 3+ years of recent professional experience in healthcare billing and medical coding (hospital, facility, clinic, healthcare insurance company, etc.)

• 3+ years of recent professional experience with OCE, MUE, and PTP edits for the NCCI classification and CMS reimbursement structures

• 5+ years of recent professional experience and knowledge of ICD-10CM, ICD-10PCS, DRG, and appropriate use of E/M Coding Guidelines, CPT Coding, Modifiers, HCPCS and CCI edits

• Experience with EHRs and Healthcare Fiscal Agent systems (Gainwell, Interchange, etc.)

• Professional coder certification with credentialing from AHIMA and/or AAPC (CCA, CCS, RHIA, RHIT, CPC-H/COC, CIC, CCS-P, CPC, and CPC-A) to be maintained annually

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: (Updated)
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 dpa_state.personnelboard@state.co.us 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, atspb.colorado.gov/board-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 the employee selection process, and/or to perform essential job functions where the requested accommodation does not impose an undue hardship. If you have a disability and require reasonable accommodation to ensure you have a positive experience applying or interviewing for this position, please direct your inquiries to our ADAAA Coordinator, Minnie Kaur, at anupreet.kaur@state.co.us.

The Department of Health Care Policy & Financing does not offer sponsored visas for employment purposes.