Job Description

Department Information

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.

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

• Reduced college tuition through CSU Global

• 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 an Enterprise Services Integration (ESI) Business & Data Analyst for the Enterprise Solution Integration (ESI) Division of the Health Information Office (HIO)!

The ESI Division of HIO exists to manage and enhance computerized claims processing and information management systems in order to assure timely and accurate Medicaid and Child Health Plan Plus (CHP+) claims processing and payments in an environment of rapid policy change. It also exists to improve the management of the Medicaid programs data integration files transmission across the Colorado Medicaid Enterprise System (CMES). The work section is responsible for researching, verifying and validating the transmission of data and integration functions and processes through the Enterprise Solutions Integration Platform and across the Colorado interchange System (iC), also known as the MMIS System, the Pharmacy Benefits Management System (PBMS), the Enterprise Data Warehouse (EDW) System, the Enterprise Testing Vendor (ETV), the Provider Call Center Module (PCC), the Electronic Data Interchange (EDI), the Program Integrity & Electronic Recovery Module (PI/RED) Electronic Visit & Verification Module (EVV), Care and Case Management Module (CCM), Social Health Information Exchange Module (SHIE), Providers of Distinction (PoD) and following the project management and portfolio management best practices and standards utilized by the Enterprise Project Management Office (EPMO). Additionally, the work unit supports the various State and Federal regulatory policy and audits of the systems, and resulting Medicaid claims reimbursement, provider enrollment and medical benefit coverage, by providing research and validation of the data mapping and transmissions of the interface files and APIs to ensure Medicaid data is mapped accordingly to the State and Federal regulatory policies and rules.

Description of Job

WHAT YOU'LL BE DOING AS ESI BUSINESS & DATA ANALYST:

• As Staff Authority, supports the Department and the Enterprise Solutions Integration Vendor by enforcing the ESI Software Development Life Cycle (SDLC) and Governance processes throughout the development of data and integration APIs & interfaces file that are transmitted across the Colorado Medicaid Enterprise Systems (CMES).

• Responsible for the successful implementation of data quality integrations across the CMES Ecosystem, directing Medicaid data access across CMES Ecosystem.

• Relied on by Contract Vendors, Department Management, and Stakeholders for day-to-day operational support to ensure Medicaid & CHP+ data exchanges occur between the CMES platform and other module systems.

• Analyzes, identifies and mitigates business, data and operational impacts to the Integration Platform, APIs & interface files that are critical to the success of data exchanges with the Module Vendors, with the understanding that many of these requests originate from State and Federal legislative mandates.

• Develops and executes advanced planning strategies with ESI, EPMO, BSD, Health IT, Contract Management and Testing Divisions within HCPF as well as CMES module vendors. The CMES Ecosystem has 24 critical modules that have direct impact on Members and Providers access to Medicaid & CHP+ benefits, services, and payments.

• Implements and executes data and integration system changes within the CMES & ESI Integration platform supporting both a waterfall and agile methodology environment Focused on a collaborative environment to deliver continuous improvement, innovation, and successful outcomes across CMES Modules.

• Implements data modeling changes within the ESI and CMES Platform by collaborating with cross functional teams and ensuring consistency with enterprise data architecture.

• Directs and executes the work to elicit, document and manage all stages of the ESI SDLC methodology to ensure each stage of the process is managed throughout the life of the project.

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:

H1C4XX

ANALYST IV

MINIMUM QUALIFICATIONS:

There are two ways to qualify for this position:

Option 1:

Experience Only:

Seven (7) total years of professional experience:

• Managing business processes, vendors, and staff for large, complex systems with data management or validations of Medicaid data

• Guiding the Software Development Life Cycle.

Option 2:

Education and Experience:

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

AND

Three (3) total years of professional experience:

• Managing business processes, vendors, and staff for large, complex systems with data management or validations of Medicaid data

• Guiding the Software Development Life Cycle.

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

• An associates 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

Note: Per the Job Application Fairness Act (Download PDF reader) , 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

• Previous relevant professional state experience

• Professional experience:

  • Working as a Systems Business Analyst, managing the SDLC methodology processes; documenting business requirements, reviewing, approving design and development documents, such as devops test results while ensuring requirements trace ability for quality results for large scale medical claims processing systems or medical information systems.

  • Working in a large claims processing system, including State Medicaid and/or Pharmacy benefits and services processing data, validating Medicaid data elements and values against identified crosswalks, validating and approving data integrations across the ecosystem.

  • Assisting and supporting programmatic strategic direction, including creating and managing long term goals for system implementation, data integration and exchanges, complex problem solving, understanding and managing data interface files, vendor management.

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:

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 (dpa_state.personnelboard@state.co.us), postmarked in US Mail or hand delivered (1525 Sherman Street, 4th Floor, Denver CO 80203), or faxed (303.866.5038) 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 (303) 866-3300; 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.

Supplemental Information

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, Anupreet Kaur, at anupreet.kaur@state.co.us.

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

Job Tags

Full time, Contract work, Temporary work, Work at office, Visa sponsorship, Flexible hours,

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