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Department

Job Summary

The Analyst, under general supervision, assists in developing Denver Health Medical Plan, Inc. (DHMP) Medicare, Medicaid and CHP+ Programs to ensure compliance with all Federal and State-level regulatory requirements. Leads and provides expert technical assistance to highly visible, sensitive, and multifaceted compliance initiatives. Assists in setting strategic direction of projects, developing project plans, analytic support services and technical expertise to a broad array of Medicare, Medicaid and CHP+ issues. Prepares monthly reports, develops marketing materials, policies, and procedures for each line of business. This position will interact with all levels of management and employees, plan members, external consultants and Federal and State representatives. The Analyst works collaboratively, fosters and promotes dialogue with CMS Regional Office, State Agencies, and Community Partners.

Essential Functions:

• Compliance
  Compiles, analyses and ensures the accuracy of data and documentation for internal and external compliance audits.
  Creates and monitors marketing materials and content to meet CMS requirements, including member handbooks/Explanation of Coverage, regulatory notifications regarding enrollment, beneficiary rights and protections, and other mandated communications. (25%)
• Strategy and Planning
  Assists in setting strategic direction of projects, developing project plans, analytic support services and technical expertise to a broad array of Medicare, Medicaid and CHP+ issues.
  (20%)
• Policy and Procedure
  Develops and drafts policies and procedures in alignment with State and Federal Requirements, ensures operationalization of policies and procedures. Identifies problems and opportunities for improvement; works collaboratively to identify solutions (20%)
• Reporting and Analysis
  Compiles reports, attestations, and other submissions to submit to the State and CMS/HPMS. Reconciles complex sets of data received from CMS or the State in order to validate reporting, financial reconciliation, and encounter submissions to align with established goals and metrics. (15%)
• Vendor Management
  Monitors external vendors or first tier entities that administer benefits for members, analyzing data to ensure compliance with contractual requirements (10%)
• Serves as Liaison between Government Product Lines and other areas of the Managed Care Department, to interpret contractual and regulatory requirements that may assist with provider, member or other operational concerns. (10%)

Education:

• Bachelor's Degree required

Work Experience:

• 1-3 years Direct health care experience with a specific emphasis on Government Health Program operations, regulatory issues, policy development, or compliance required.

Licenses:
Knowledge, Skills and Abilities:

• Extensive knowledge of managed care/health care administration, policy and compliance.
• Ability to develop data requirements and work with operations teams and groups to extract, organize and analyze data and trends.
• Ability to define problems: collect data, establish facts and draw valid conclusions to implement solutions.
• Demonstrates ability to manage multifaceted projects in conjunction with day-to-day activities.
• Excellent interpersonal and customer service skills, ability to work collaboratively with other corporate groups (such as Compliance Department, and Information Systems), external vendors and State and Federal entities.
• Self-motivated and takes initiative: identifies, acts on, and documents solutions for gaps and opportunities for process improvements.
• Critical thinking, strong written and verbal communication skills, and the ability to effectively interact within a team.
• Proven ability to interpret and synthesize Federal and State regulatory requirements, ensuring policies, procedures and processes are updated to comply with guidelines.
• Assists in monitoring of risk assessments, preparation and compilation of audit requirements interprets audit results; monitors daily, weekly and monthly reports.
• Proficiency in Health Plan Management Software involving Claims, Enrollment systems, and Government Data Portals.
• Knowledge of PC applications, specifically Microsoft Office products, and the ability to learn to computer applications.

*Remote Opportunity. Must Be a Colorado Resident.*

Shift

Work Type

Salary

Benefits

• Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans

• Free RTD EcoPass (public transportation)

• On-site employee fitness center and wellness classes

• Childcare discount programs & exclusive perks on large brands, travel, and more

• Tuition reimbursement & assistance

• Education & development opportunities including career pathways and coaching

• Professional clinical advancement program & shared governance

• Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program

• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

Our Values

• Respect

• Belonging

• Accountability

• Transparency

All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.

Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver's 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.

As Colorado's primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.

Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.

We strongly support diversity in the workforce and Denver Health is an equal opportunity employer (EOE).

Denver Health values the unique ideas, talents and contributions reflective of the needs of our community. For more about our commitment to diversity visit:

Applicants will be considered until the position is filled.