Remote Healthcare BA with 837 claims, behavioral health, medical financial data, contracting/technical writing, CPT/HCPCS/Revenue codes, Agile, Encounter processing, PHI, HIPAA, 42 CFR Part II experience

Job ID: CO-Alternative Payment Model (APM) Business (99090629)

Remote Healthcare BA with 837 claims, behavioral health, medical financial data, contracting/technical writing, CPT/HCPCS/Revenue codes, Agile, Encounter processing, PHI, HIPAA, 42 CFR Part II experience

Location: Denver CO (CDHS (Office of Behavioral Health))
Duration: 9+ months

Familiarity with 837 claims data or other behavioral health or medical financial data
Drafting language for contracts; working with contracts
Uniform Coding Standards (CPT/HCPCS/Revenue Codes)
Experience in Agile and/or Health IT environment
Claims/Encounter processing

Preferred Qualifications
Expertise in technical writing and construction of protocols and requirement documentation.
Excellent interpersonal, verbal, and written communication and public speaking skills.
Self-motivated and able to effectively manage time and tasks.
Ability to solve complex problems, participate in continuous improvement, and adapt to the ideas of others.
Expertise in PHI, HIPAA, 42 CFR Part II data security, privacy regulations and consent management

Highly Desirable Characteristics
Ability to work effectively with key stakeholders, speak and write authoritatively and compellingly, resolve communication problems, and negotiate and manage competing interests.
Ability to work well with stakeholders regardless of position and authority, contribute to workgroups and committees, and adhere to clear lines of responsibility and accountability.

Education and Experience
Education: Graduation from an accredited college or university with a bachelor’s degree.

Additional, relevant, paid or unpaid experience can substitute for the required education on a year-for-year basis.

This role serves as the liaison between the Behavioral Health Administration (BHA) Finance Team, the Data & Evaluation Team and the Medicaid Management Information System (MMIS) team at the Department of Health Care Policy & Financing (HCPF) to elicit business requirements for future BHA claims and encounter processing. They will have experience with alternative payment models that align with the payers’ efforts to shift away from fee-for-services payments to value-based payments. They will have experience with physical and/or behavioral health data.

Description of Job
This position exists to support development of payment models and business processes with a level of technical expertise of healthcare payment business processes and payment models. Position is essential in doing work to develop new rate setting processes. This work can include data analysis, working with actuaries on rate setting methodologies, contract management and stakeholder engagement.

Primary Duties Include
Reimbursement Policy and Rate Model Development

Determines what data is necessary for rate setting purposes for different types of payment methodologies.
Helps to determine if quality measures can be executed with existing management guidance or if further clarification is necessary to do the work.
Must decide how best to pull and analyze data.
This position must be able to understand potentially complex rate models and be able to help providers understand their rates and the financial implications involved.
Translating complex financial models into contractual language for our providers.
Project Management and Operational Planning to Implement Payment Reform

Collaborate with agency stakeholders to develop new payment models for behavioral health services.
Decides what tasks need to be completed to develop new payment methodologies.
Must determine what tasks are a payment reform team task or if other Department staff or outside contractors are needed to assist with implementation.
Decides in which order, and when, to perform these structured tasks.
Data Analysis Supporting Payment Reform

Position escalates issues raised by stakeholders that exceed the legal and regulatory knowledge of this first working level position.
In responding to stakeholder inquiries and concerns, position evaluates management guidance, then decides when is appropriate to ask for assistance if the stakeholder inquiry is outside of the scope of the guidance that the position relies upon.
Decides appropriate time to ask for permission to escalate to other Departmental staff as needed to address complex stakeholder inquiries or concerns
Under the direction of a senior analyst, position queries, analyzes, and prepares data for use in analyzing the policy merits of potential payment methodology reforms.
Position becomes knowledgeable about a very large set of underlying data that must be queried in different ways depending on the particular extant payment methodology.
Position tabulates and compiles data into formats that are useful and understandable to a variety of audiences of varying sophistication and skill.

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