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Colorado State Medicaid Benefits Policy Specialist in Denver Metro, Colorado

Medicaid Benefits Policy Specialist



Medicaid Benefits Policy Specialist


$4,284.00 - $4,500.00 Monthly


Denver Metro, CO

Job Type

Full Time


Department of Health Care Policy and Financing

Job Number


Max Number of Applicants



1/24/2021 11:59 PM Mountain

  • Description

  • Benefits

  • Questions

Department Information

Make a Difference! Join HCPF by improving health care access and outcomes for the people we serve while demonstrating stewardship of financial resources.



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.

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 access and outcomes for the people we serve while demonstrating sound stewardship of financial resources. We work to make our members healthier while getting the most for every dollar that is spent. We are looking for a Medicaid Benefits Policy Specialist to join our Health Programs Office (HPO) 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)

  • 10 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.

  • Discounted RTD EcoPass

The HPO Benefits and Services Division is responsible for the administration and performance of Medicaid acute care services and programs. Services and programs include both physical health and behavioral health. Staff within the Division are responsible for stakeholder relations, policy development and implementation, contract management and performance, program administration and overall Medicaid program performance. The Division plays an important role in working toward HCPF's mission to improve access to cost-effective, quality health care services for Coloradoans. The Benefits Management Section is responsible for developing, implementing and administering benefit policy for Medicaid acute care services and programs. This section leads Division rules, fiscal notes, legislative analysis, State Plan Amendments and overall performance of the Medicaid program. The Benefits Management team is also responsible for maximizing the performance of Medicaid services and programs.

Description of Job

  • Designs, analyzes, and develops home health services, private duty nursing services, hospice services policies as needed.

  • Coordination of these benefits requires the position to research and recommend best practices; identify and address benefit or policy gaps; respond to provider inquiries about benefit limitations and policies; participate in quality improvement reviews, and assess current and future benefit policies, as well as collaborate with the Long-Term Services and Supports Section and the Division for Developmental Disabilities Section to meet the Department's expectations for efficient, cost-effective, quality care of clients.

  • Develops productive working relationships and collaborates with stakeholder groups and individuals to constructively address disagreements and policy challenges that are critical to the success of the benefit.

  • Collaborates with other sections to ensure all services managed by this position are included in managed care contracts and known to the Regional Accountable Entity (RAE) within the Accountable Care Collaborative (ACC); provides recommendations to other benefit and/or programs managers for ways to define and implement specialty care services for new programs or populations, and/or helps align current programs with the coverage policies of physician services.

  • Serves as a liaison between the Department's various stakeholders, such as professional associations, providers, clients, advocates, sister state agencies, and lobbyists.

  • Identifies and establishes metrics and/or benchmarks to monitor policy changes, track and monitor utilization and expenditures, provide or participate in quality improvement reviews, assist with the operation of Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes, and identify ways to enforce policy changes through claims system edits or prior authorization request requirements/criteria. Position identifies issues that require additional clarification, and drafts necessary Provider Bulletin articles and makes necessary updates and revisions to respective billing manuals.

  • Maintains knowledge and familiarity of Colorado Medicaid legal requirements by researching and analyzing the pertinent State and Federal laws and regulations and the Colorado Medicaid State Plan to identify areas where home health services, private duty nursing services, hospice services , State Plan, or Colorado Code of Regulations may need to be amended

Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights


Education and Experience:

  • Bachelor's degree from an accredited institution Bachelor's degree from an accredited institution in a field of study related to the work assignment AND

  • Two years of professional experience in Healthcare Administration, Public Health, Public Policy , or related field.


  • A combination of work experience in the occupational field or specialized subject area of the work assigned to the job, which provided the same kind, amount, and level of knowledge acquired in the required education, may be substituted on a year-for-year basis for the bachelor's degree.

  • A master's or doctorate degree from an accredited college or university in a field of study related to the work assignment may be substituted for the bachelor's degree and at the agency's discretion, one or two years of general experience respectively. Additional appropriate experience will substitute for the degree requirement on a year-for-year basis

Preferred Qualifications

  • JD or Master's degree in a health related field

  • Policy administration, interpretation, and implementation experience, particularly with state/local governments related to healthcare

  • Experience with claims billing and coding

  • Experience with Medicaid Benefits home health services, private duty nursing services, and hospice services

  • Data experience including Medicaid Management Information System (MMIS) and Cognos or related system

  • Cross-functional project management experience including plan drafting, project timelines, and deliverables reporting

  • Stakeholder engagement experience including public speaking and meeting facilitation

  • Ability to adapt a style to fit diverse audiences of varying technical levels, and at various levels within an organization, in groups and individual settings

  • Critical thinking; ability and motivation to develop creative solutions to complex problems, and systemic challenges.

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.


  • All positions at HCPF are security sensitive positions and require 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.


If you receive notice that you have been eliminated from consideration for the position, you may protest the action by filing an appeal with the State Personnel Board/State Personnel Director within 10 days from the date you receive notice of the elimination. Also, if you wish to challenge the selection and comparative analysis process, you may file an appeal with the State Personnel Board/State Personnel Director within 10 days from the receipt of notice or knowledge of the action you are challenging. Refer to Chapters 4 and 8 of the State Personnel Board Rules and Personnel Director's Administrative Procedures, 4 CCR 801, for more information about the appeals process. The State Personnel Board Rules and Personnel Director's Administrative Procedures are available at A standard appeal form is available at: If you appeal, your appeal must be submitted in writing on the official appeal form, signed by you or your representative, and received at the following address within 10 days of your receipt of notice or knowledge of the action: Colorado State Personnel Board/State Personnel Director, Attn: Appeals Processing, 1525 Sherman Street, 4th Floor, Denver, CO 80203. Fax: 303-866-5038. Phone: 303-866-3300. The ten-day deadline and these appeal procedures also apply to all charges of discrimination.

Supplemental Information


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.

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 (HCPF) 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 HCPF ADAAA Coordinator, Debra Becerra at or 303-866-4438.


Technical Help

If you have trouble uploading or attaching documents to your online application, or for any other technical difficulties, call NEOGOV technical support at 855-524-5627 anytime between 6:00 a.m.-6:00 p.m. (Pacific Time).