Eligibility Quality Reviewer Jobs in Denver, CO at State of Colorado Job Opportunities

Title: Eligibility Quality Reviewer

Company: State of Colorado Job Opportunities

Location: Denver, CO

Department Information

Medicaid Operations Office

Make a difference-Join HCPF by improving health care access and

outcomes for the people we serve while demonstrating stewardship of

financial resources.
Information about the Department:

**This announcement will remain open until advertised or

until 50 applications have been received; whichever occurs first.

Eligible applicants are encouraged to apply early.**

The Department of Health Care Policy and Financing (Department)

offers a competitive benefits package to include the Public

Employees Retirement Account (PERA), 401k/457, health/dental

insurance options, 10 holidays, accrual of paid sick and

vacation/annual time, flex place and flex time. The Department is

also centrally located; offers affordable ECO passes; has a fitness

center on-site; and a variety of discounts on services and products

are available to state employees through the State of Colorado’s

Work-Life Employment Discount Program. The Department also

encourages employees to take advantage of advanced education and

offers reduced college tuition through CSU Global for their

employees. This Department is a “Tobacco Free Workplace”.www.colorado.gov/hcpf

The Medicaid Operations Office oversees health plan operations

administered by the Department. This office is responsible for the

overall operations of Medicaid, including Child Health Plan Plus

(CHP ). This office manages the daily operations of Medicaid to

ensure compliance with Federal and State laws, rules and

regulations. In addition, this office is responsible for

establishing and monitoring the operational performance standards

(e.g., call center performance standards, claims payment standards,

enrollment processing standard, etc.) for contractors working for

the Department. This office establishes systems for robust

monitoring of health plan operations, oversees the collection of

information necessary for performance monitoring and directs staff

reviews to identify and mitigate compliance risks. This office has

oversight of claims payment operations, the member and provider

call centers; the member identification card contractor; and

eligibility determinations made by eligibility sites and monitoring

of county partners.

Description of Job

This position reviews the accuracy and timeliness of the Medical

Assistance program’s eligibility determinations to find and report

compliance with federal and state eligibility rules and procedures.

This position identifies review requirements based on error trends.

This position also tracks trends in errors in order to affect

change through corrective actions and to protect Medical Assistance

programs dollars and interests. This position advises state and

eligibility site administrators of review findings through

individual case reports and project summary reports. This position

recommends ways to improve the accuracy and timelines of

eligibility determinations assuring clients better access to

medical assistance programs. This position responds to state audit

recommendations by researching findings, reporting progress, and

conducting informal random reviews and work site visits.

Flexibility for in-state travel with potential overnight duration

may be necessary to attend/conduct onsite reviews, trainings, or


Minimum Qualifications, Substitutions, Conditions of

Employment & Appeal Rights


Education and Experience:


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