Medicaid Operations Data Analyst

Medicaid Operations Data Analyst Print (Apply Medicaid Operations Data Analyst Salary $4,935.00 - $6,080.00 MonthlyLocation Denver Metro, COJob TypeFull TimeDepartmentDepartment of Health Care Policy and FinancingJob NumberUHA04146_08.2022 (REPOST)Closing8/30/2022 11:59 PM Mountain Description Benefits Questions Department InformationSTATE OF COLORADO RESIDENCY REQUIRED 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 Medicaid Operations Data Analyst to join our Analytics Investigations and Recoveries (AIR) Section Office in the Medicaid Operations Office! The Departments Fraud, Waste, and Abuse/Program Integrity Division, Analytics Investigation & Recovery (AIR) Section, provides data and analytical support to the Fraud, Waste, and Abuse/Program Integrity Division with the goal of preventing, detecting, and deterring fraud, waste and abuse in the Colorado Medicaid Program. The AIR Section conducts data mining reviews of paid claims to identify possible overpayments for recovery from providers, monitors provider compliance with statutes and regulations, identifies suspected fraud, and identifies program deficiencies evidenced in claims and member data. Statistical analysis and other data analysis techniques are extensively utilized in performing these functions.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 plansMedical (, Dental (, and Vision (insurance coverageAutomatic Short-Term and Optional Long-Term Disability Coverage (and AD&D InsuranceFlexible 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 (Sick Leave for State of Colorado Temporary EmployeesFlexplace and Flextime work arrangementsVariety of discounts on services and products available through the State of Colorado''s Work-Life Employment Discount ProgramFree RTD EcoPass (to all eligible State EmployeesReduced college tuition through CSU Global (Union of Colorado Membership Eligibility This position can work fully remotely from anywhere in the State of Colorado. Please note - equipment provisioning and certain onboarding tasks will take place in person, in our downtown Denver office, on the first day of employment. Description of JobWhat you''ll be doing: This position develops new standardized procedures for the AIR Section, participates in efforts to develop and document best practices, and designs new research project opportunities. Additional duties include, but are not limited to:Developing and completing a range of statistical and data analyses of eligibility and claims data in multiple data warehouses to support the Divisions data mining functions of identifying potential vulnerabilities, suspected fraud, and possible overpayments. Comparing Medicaid claims data to other data.Utilizing database software made available by the Department and descriptive statistical techniques to extract, manage, analyze, and summarize Medicaid data and other data that may be available. Developing and completing a range of analyses and reports using software provided by the Department employing various techniques, including statistical software, data analytics, algorithm development, data matching, and regression analysis. Identifying potential issues in the CBMS database and utilizing research skills to generate reports that will be the basis for further investigation by the Eligibility Division. Evaluating alternative methods to detect eligibility related issues and program revisions to improve compliance monitoring. Conducting assigned, routine, and monthly data analysis projects as well as formulating original projects to monitor system compliance with Medicaid statutes and regulations. Documenting all analyses in the format required by Section standard operating procedure. Providing data analytical support to the FWA/PI Division. Collaborating with others and working with team to accomplish Analytics Investigation & Recovery (AIR) Section goals.Minimum Qualifications, Substitutions, Conditions of Employment & Appeal RightsMINIMUM QUALIFICATIONS:Education and Experience:Bachelor''s degree from an accredited institution in Mathematics, Statistics, Economics, Political Science, Public Administration or related fields or a field of study related to the work assignment.ANDTwo years of professional experience in data analysis/science.Substitutions:Additional appropriate experience will substitute for the degree requirement on a year-for-year basis.Additional appropriate education will substitute for the required experience on a year-for-year basis.Preferred Qualifications: Experience working in the CBMS database and/or knowledge of Medicaid eligibility Advanced SQL skills working with disparate data sources and structures Prior state experience related to the duties of this position 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 EMPLOYMENTAll 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. 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 ( [Click Here to Email Your Resumé] ), 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 departments 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 InformationHow 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 [Click Here to Email Your Resumé] [Click Here to Email Your Resumé]) . The Department of Health Care Policy & Financing does not offer sponsored visas for employment purposes.

Created: 2025-11-15