State of Colorado
Contract Administrator II- Pueblo
State of Colorado, Denver, Colorado, United States,
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, 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 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 candidate's 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. Duties 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 judgment, 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:
Five (5) years of relevant experience including at least three years in:Medical claims processing,Medicare/Medicaid billing knowledge,Physician and hospital billing practices,Knowledge of CPT, HCPCS, and ICD codes.OREducation 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 ICD codes (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 necessary.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.How to Apply
The Assessment Process
For additional recruiting questions, please contact jazzma.gamboa@state.co.usAbout 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
(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.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~
#J-18808-Ljbffr
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, 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 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 candidate's 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. Duties 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 judgment, 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:
Five (5) years of relevant experience including at least three years in:Medical claims processing,Medicare/Medicaid billing knowledge,Physician and hospital billing practices,Knowledge of CPT, HCPCS, and ICD codes.OREducation 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 ICD codes (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 necessary.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.How to Apply
The Assessment Process
For additional recruiting questions, please contact jazzma.gamboa@state.co.usAbout 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
(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.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~
#J-18808-Ljbffr