Job Information
State of Colorado Contract Administrator II- Pueblo in Statewide, Colorado
Contract Administrator II- Pueblo
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Contract Administrator II- Pueblo
Salary
$49,848.00 - $79,776.00 Annually
Location
Statewide, CO
Job Type
Full Time
Job Number
IIB 01127 9/26/24
Department
Colorado Department of Human Services
Division
OBH - CMHIP
Opening Date
09/26/2024
Closing Date
10/13/2024 11:59 PM Mountain
FLSA
Determined by Position
Type of Announcement
This position is open only to Colorado state residents.
Primary Physical Work Address
1600 W. 24th Street, Pueblo CO OR 3520 West Oxford Ave. Denver, CO 80236
FLSA Status
Exempt; position is not eligible for overtime compensation.
Department Contact Information
jazzma.gamboa@state.co.us
How To Apply
Please submit an online application for this position at https://www.governmentjobs.com/careers/colorado. Reach out to the Department Contact to apply using a paper application, including any supplemental questions. Failure to submit a complete and timely application may result in the rejection of your application. Applicants are responsible for ensuring that application materials are received by the appropriate Human Resources office before the closing date and time listed.
Description
Benefits
Questions
Department Information
This position is open to current Colorado Residents only.
Most State of Colorado employees are eligible for a great benefit package! Please see the Supplemental Information section below for details!
About Forensic Services under Office of Civil and Forensics Mental Health (OCFMH)
Located within the Colorado Department of Human Services, the OCFMH is the State’s behavioral health authority. OCFMH is responsible for policy development, service provision and coordination, program monitoring and evaluation, and administrative oversight of the public behavioral health system. OCFMH funds supports and monitors numerous mental health and substance abuse community programs and providers, and reviews and designates the State’s 27-65 providers. The Mental Health Hospitals (MHH) Division is an organizational work unit within the OCFMH. This work unit is responsible for the overall management of CMHHIP, CMHHIFL, Forensic Services Division, and the Mental Health Transitional Living Homes (MHTL Homes), including all patients, programs, and activities. The Mental Health Hospitals at Fort Logan and Pueblo (“Hospitals”) and Forensic Services, under the auspices of the Office of Civil and Forensics Mental Health (OCFMH), partner with patients, families and their communities to provide quality services that assist patients in achieving their mental health and health care goals. The Hospitals'/Forensic Services CFO Office is an organizational work unit within the Operations/Administrative Services Office within the Office of Behavioral Health. This work unit is responsible for the budget development, management, and monitoring of all resources (fiscal/FTE) for the Hospitals, as well as contract facilitation and management. This unit is responsible for responding to all fiscal oriented subject matter in relation to federal, legislative, departmental, and external stakeholders, including providers.Opt-in below to receive text message updates on CDHS recruiting events!
CDHSCareers
Description of Job
THIS IS A HYBRID POSITIONThis position is scheduled Monday-Friday 8am-5 pm, and will be a blend of remote and in-person work (shared space in an office environment)
The location of this position (Denver or Pueblo) will be determined based on the selected candidates' preferred location.
About the Position:
This position’s primary responsibility is to verify and process the outside medical leave payments for the Mental Health Hospitals in Pueblo and Ft. Logan. This position is the liaison between Medicare and the Hospitals for billing issues and denials, provides training, assists the Medicare billing team in processing claims to Medicare, and reviews and processes payee accounts for the Hospitals. Dutes in this position include:Outside Medical:
Analyze claims using independent judgment to assess and determine how to pay claims based on contractual agreement and rates
Draft a contractual single case agreement with medical vendors for catastrophic or unique medical situations outside of existing contract agreement scopes;
Verify invoices of services by comparing service dates to discharge reports or comparable BEHR codes, and proper signature authority of OMS approval
Train assigned Patient Financial Services staff how to review the patient’s file for benefit information to determine who is financially liable for the medical charges when patients are admitted to acute hospitals. Serve as backup to notify Medicare Billing Supervisor or Patient Financial Services Director of determination for approval. Once approved, send notification to appropriate Institute, OBH, and Accounting staff;
Review and, using independent judgement, recommend coding by fund, agency, organization unit, appropriation, object, sub-object, grant budget line, balance sheet account and reporting category
Analyze claims using independent judgment to assess and determine if claims are to be processed or denied based on information provided in the Patient Financial Services financial determination, provider agreements, and CMS regulations for allowable charges
When discrepancies arise, pursue resolution to the appropriate service (provider, program, purchasing, etc.) If claims are received for disallowed services, denials are processed and submitted to the provider The provider may resubmit the claim with correct information or with acceptable CPT code(s) if they choose to dispute the denial. Only the OMS program or OCFMH MHH CFO can approve final denial once a provider disputes accounting’s denial
Reprice acceptable claims to calculate appropriate payment amount based on current contractual agreements with providers
Maintain multiple (physician, AMR, lab, durable medical, ASC, medications, injections, etc.) Medicare fee schedules for use in repricing the claims
Upon verifying claims are appropriate and have accurate pricing, submit to the accounts payable accounting technician for processing of vendor invoices in CORE;
Utilize BEHR reports and reconciliation at year-end to identify and request outstanding invoices for processing prior to fiscal year closeout
Notify OCFMH MHH CFO of purchase order balances by providing a report monthly during the year and weekly during the last quarter of the fiscal year.
Electronic Health Record System Reports:
Review the outside medical leave reports to outside medical payments processed
Reconcile leave date on the invoice against the date on the BEHR leave report
Verify that CMHIP and CMHIFL have been billed appropriately when agency financial responsibility is determined by Patient Financial Services
If there is not a bill when one is expected, contact the appropriate vendor to determine if Medicare was billed in error. If so, instruct vendor to refund Medicare and bill CMHIP or CMHFL as appropriate
The reconciliation is updated at least monthly and vendors are notified when an expected claim is outstanding for 90 days. This duty requires diligence and timely follow-up with vendors as needed until all claims have been appropriately billed.
Other Duties as Assigned:
- will be required to perform other duties assigned to the Office of Behavioral Health, as defined by the Chief Financial Officer within the scope of the classification. These duties may be for a temporary assignment, assistance to others within the unit, related to a special project, or assigned indefinitely
Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights
Minimum Qualifications:
Five (5) years of relevant experience including at least three years in Medical claims processing, Medicare/Medicaid billing knowledge, Physician and hospital billing practices and Knowledge of CPT, HCPCS and ICD codes
OR
Education and Experience:
A combination of related education and/or relevant experience in an occupation
related to the work assigned equal to five (5) years.
Preferred Qualifications:
Experience with medical claims processing (3+ years of experience)
Medicare/Medicaid billing knowledge (3+ years of experience)
Understanding of medical/billing accounting structures (3+ years experience)
Experience with physician and hospital billing practices (3+ years of experience)
Knowledge of CPT, HCPCS, and all ICDcodes (3+ years experience)
Experience contacting physician offices and hospitals to verify billing and payment status and discussing billing issues (3+ years experience)
Familiar with Medicare/Medicaid rules and regulations
Proficient with Microsoft Excel
Strong verbal and written communication skills
Conditions of Employment:
Standard Background check: CBI name check, ICON Colorado court database, Medicare fraud database, Reference checks
Occasional Travel may be neccessary
TB Testing, COVID 19 and other vaccines as required by the State of CO
Former State employees who were disciplinarily terminated or resigned in lieu of termination must (1) disclose that information on the application (2) provide an explanation why the prior termination or resignation should not disqualify the applicant from the current position, (3) provide the employee number from the applicant’s prior State employment. Absent extraordinary circumstances, prior disciplinary termination or resignation in lieu of termination and failure to provide this information will disqualify the applicant from future State employment with CDHS.
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 (https://cdhs.colorado.gov/information-for-job-applicants#how-to-apply)
The Assessment Process
For additional recruiting questions, please contact jazzma.gamboa@state.co.us (stephanie.karle@state.co.us)
About Us:
If your goal is to build a career that makes a difference, consider joining the dedicated people of the Colorado Department of Human Services (https://www.colorado.gov/cdhs) (CDHS). Our professionals strive to design and deliver high quality human and health services that improve the safety, independence, and well-being of the people of Colorado. In addition to a great location and rewarding and meaningful work, we offer:
Strong, secure, yet flexible retirement benefits including a PERA Defined Benefit Plan or PERA Defined Contribution Plan www.copera.org plus 401(k) and 457 plans
Medical and dental health plans
Employer supplemented Health Savings Account
Paid life insurance
Short- and long-term disability coverage
11 paid holidays per year plus vacation and sick leave
BenefitHub state employee discount program
Employee Wellness program (https://coloradostateofhealth.com/)
Excellent work-life programs, such as flexible schedules, training and more
Remote work arrangements for eligible positions
*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 .
Our Values:
We believe in a people-first approach: To serve the people of Colorado, we develop a culture and work environment that creates an energized, inspired, and healthy team capable of giving their best to Coloradans .
Balance creates quality of life: We want our team to be resilient through a supportive workplace that values flexibility, health and wellness, and employee engagement.
We hold ourselves accountable: We take responsibility through our actions, programs, and results for the state of health and human services in Colorado.
Transparency matters: We are open and honest with employees, our partners, the Coloradans we serve, and the public.
We are ethical: We abide by what is best for those we serve by doing what is right, not what is easy.
Collaboration helps us rise together: We work together with all partners, employees, and clients to achieve the best outcomes for Coloradans.
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.
ADAA Accommodations: CDHS 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 ADAA Coordinator, Nancy Schmelzer, at cdhs_ada@state.co.us or call 1-800-929-0791.
THE STATE OF COLORADO IS AN EQUAL OPPORTUNITY EMPLOYER (https://cdhs.colorado.gov/information-for-job-applicants#eoe)
Toll Free Applicant Technical Support
The State of Colorado offers permanent employees a variety of benefits including medical, dental, life and disability insurance, as well as a comprehensive leave program. Please click the following link for detailed information: www.colorado.gov/pacific/dhr/benefits
Please note that each agency's contact information is different; therefore, we encourage all applicants to view the full, official job announcement which includes contact information and class title. Select the job you wish to view, then click on the "Print" icon.
01
If you are a current or former State of Colorado employee, please list your employee number (starts with 997...). Failure to provide this requested information may render your application incomplete, and you may no longer be considered for the position.
02
Former State employees who were disciplinarily terminated or resigned in lieu of termination must disclose the information on the application. In the space below, please provide an explanation as to why the prior termination or resignation should NOT disqualify your application from the current position.
03
The bottom of this job announcement provides links to additional information on how to apply, the assessment process, toll free applicant technical support, and about how the State of Colorado is an equal opportunity employer. Please acknowledge below that you have read the information provided in these links.
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I am unable to access the links with this information on the job posting. (If you select this option, please contact the recruiter, whose information is listed on this announcement, so that they can send this information directly to you.)
04
Your legal name is used in the hiring process for background checks. Did you use your full legal name in your application? If not, please update your information before submitting your application.
Yes
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05
Why do you feel you are the best candidate for this position?
06
Please describe your experience with Medicaid and Medicare billing practices.
07
Please describe your experience with Medicaid and Medicare billing practices.
08
Describe the software programs you have used.
09
Please describe your experience with contacting physicians or hospitals regarding billing concerns or issues.
10
Describe your experience with electronic health records.
Required Question
Agency
State of Colorado
Address
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Website
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