Provider Field Representative

Job Description

**Department Information**
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**STATE OF COLORADO RESIDENCY REQUIRED AT TIME OF APPLICATION** **NOTE: This announcement may be used to fill multiple openings.**

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 Provider Field Representative to join our Provider Relations Unitteam!

The Provider Relations Unit within the Fiscal Agent Operations (FAO) Division exists to perform Medicaid provider outreach, enrollment support, recruitment and retention, and ongoing provider relations. The unit’s goals include mapping the current Medicaid provider network, performing gap analyses, resolving provider issues, and developing and implementing a cross-functional Department provider outreach/relations strategy. The ultimate goals are to build and maintain a robust provider network that meets the needs of Medicaid and CHP+ members and to develop a positive relationship with the provider community.

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 hybrid, to full-time in the office. Specific discussions about the schedule will be discussed during the offer stage.*
**Description of Job**
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This position collaborates with and supports current and potential providers, including primary care physicians, physician extenders, specialists, dentists, behavioral health providers, long-term service providers, hospitals, and ancillary service providers. Support includes answering questions, providing guidance, and resolving issues related to provider enrollment and revalidation, reimbursement/claims, portal access, service authorizations, and policies that impact these areas.

Duties include, but are not limited to:

* Resolving most provider issues related to claims and billing, service authorizations, provider portal access, and ancillary processes, and seeking collaboration with contractor teams, as appropriate
* Using a variety of strategies to help providers collaborate on effective solutions and shifting strategies, as needed, to adjust provider needs
* Ensuring management is kept apprised of any situations with potential for escalation outside the Department
* Collaborating with fiscal agent contractors and FAO resources, as needed, to respond to provider questions and resolving issues related to initial enrollment, change requests, and revalidation in the Colorado interChange system
* Responding to internal and external ad hoc information requests and participating in workgroups focused on special projects
* Developing and maintaining relationships with Department policy staff and external contractors (e.g. utilization management vendor, managed care organizations, dental ASO) to facilitate accurate and timely resolution of non-standard provider requests
* Assisting with developing training materials and presentations based on established processes and provider input
* Other duties as assigned

**Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights**
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**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)**

H1B3XX ADMINISTRATOR III

**MINIMUM QUALIFICATIONS:** **There are two ways to qualify for this position:** **Option 1:****Experience Only:**
Six (6) years of related professional customer-facing healthcare experience. **Option 2:****Education and Experience:**
A Bachelor’s degree from an accredited institution in a related field and two (2) years of professional customer-facing healthcare experience. ***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**

**PREFERRED QUALIFICATIONS*** Prior state experience related to the duties of this position
* Experience in customer service
* Experience in medical billing or claim issues
* Experience in healthcare field

**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.
* Occasional in-state and possibly overnight travel may be required.

**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 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.
**Supplemental Information**
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**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, Virginia Miller, at virginia.miller@state.co.us.

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