Caregiver and LTC UR/UM Compliance Specialist-Term Limited

Full Job Description

STATE OF COLORADO RESIDENCY REQUIRED AT TIME OF APPLICATION

This is a term limited position funded until 6/30/2028.

NOTE: This announcement may be used to fill multiple openings.

Envision Yourself Working at HCPF

The State of Colorado strives to create a Colorado for All by building and maintaining workplaces that value and respect all Coloradans through a commitment to equal opportunity and hiring based on merit and fitness.

The State is resolute in non-discriminatory practices in everything we do, including hiring, employment, and advancement opportunities.

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.

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 plans

• Medical, Dental, and Vision insurance coverage

• Automatic Short-Term and Optional Long-Term Disability Coverage

• Life and AD&D Insurance

• Flexible 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

• Accrued Sick Leave for State of Colorado Temporary Employees

• Flexplace and Flextime work arrangements

• Variety of discounts on services and products available through the State of Colorado's Work-Life Employment Discount Program

• Free RTD EcoPass to all eligible State Employees

• Reduced college tuition through CSU Global

• Credit Union of Colorado Membership Eligibility

• 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.https://dhr.colorado.gov/dhr-resources/student-loan-forgiveness-programs

We are looking for a Caregiver and LTC UR/UM Compliance Specialist for the Office of Community Living!

We are onboarding new employees using a hybrid approach. The Department supports flexible work arrangements.

Depending on the business need and description of the position, we have options that range from hybrid to full-time in the office.

Specific discussions about the schedule will be discussed during the offer stage.

**Please note - equipment provisioning and certain onboarding tasks will take place in person, in our downtown Denver office, on the first day of employment.**

Requirements

Position Summary

The Colorado Department of Health Care Policy & Financing (HCPF) is seeking a Compliance Specialist to support financial oversight, contract management, and operational integrity within the Office of Community Living (OCL).

This position plays a critical role in ensuring Home and Community-Based Services (HCBS) providers and vendors comply with state and federal regulations, departmental standards, and fiscal requirements.

This role combines financial compliance auditing, contract and vendor management, and program operations support to help maintain accountability, transparency, and high-quality service delivery across long-term care programs.

Key Responsibilities

• Conduct financial compliance reviews of approximately 900 HCBS family caregivers and providers to ensure adherence to Department-established standards and service limitations.
• Review supporting documentation (e.g., payroll records, timesheets, pay stubs, and claims data) to assess compliance and identify overbilling or excess units.
• Calculate overpayments and determine compliance or non-compliance based on established thresholds.
• Communicate with providers throughout the audit process via written correspondence and verbal engagement.
• Draft and issue notification letters, corrective action plans, closeout letters, and final findings in accordance with C.R.S. 25.5-4-301.
• Provide technical assistance and guidance to providers to resolve compliance issues and implement corrective actions.
• Maintain complete and accurate documentation of all reviews, communications, and outcomes in accordance with unit standards.
• Ensure all reviews align with Generally Accepted Government Auditing Standards (GAGAS) and Generally Accepted Accounting Principles (GAAP).
• Support appeals by preparing documentation and coordinating with leadership as needed.
• Aggregate and analyze data for internal and external reporting, including leadership, legislative, and federal reporting needs.
• Support management of complex vendor contracts within the Long-Term Care Utilization Review and Utilization Management (LTC UR/UM) program.
• Draft, review, and negotiate contract language, amendments, and interagency agreements (IAs) to ensure clarity, compliance, and risk mitigation.
• Monitor vendor performance, ensuring adherence to contractual requirements and program expectations.
• Review deliverables for accuracy and compliance; coordinate with benefit managers and vendors to resolve issues.
• Participate in procurement activities, including drafting statements of work, evaluating proposals, and supporting vendor selection.
• Coordinate across divisions, benefit managers, system administrators, and external partners to address contract-related issues and ensure alignment with Department priorities.
• Oversee vendor system functionality and ensure operational and policy requirements are met.
• Facilitate effective communication with vendors and internal stakeholders through meetings, transmittals, and shared systems.
• Conduct quality assurance reviews and process vendor invoices in compliance with State Fiscal Rules.
• Review invoices against deliverables and contract terms to ensure accuracy prior to payment.
• Submit receiving reports and invoices for payment and track payments through completion.
• Resolve discrepancies, errors, and returned payments in coordination with Accounts Payable and internal teams.
• Maintain compliance with fiscal procedures, including email archiving and documentation standards.
• Track errors and trends to inform process improvements, training, and outreach.
• Contribute to development and monitoring of contract spending plans and forecasts.

Qualifications

Residency Requirement:

This posting is only open to residents of the State of Colorado at the time of submitting your application.

Minimum Qualifications

Compliance Specialist III (H1G3XX)

There are two ways to qualify for this position:

Option 1:

Experience Only:

Six (6) total years of professional experience conducting compliance or fiscal reviews and/or working in Home and Community Based Services (HCBS).

Option 2

Education and Experience:

Bachelor's degree from an accredited institution in Health Care Administration, Public Health, Public Administration, Health Services, or a related field

AND

Two (2) total years of professional experience conducting compliance or fiscal reviews and/or working in Home and Community Based Services (HCBS).

Appropriate education will substitute for the required experience on a year-for-year basis. Relevant education will be calculated as the following:

• An associates will count as two years of experience

• A bachelors will count as four years of experience

• A masters degree will count for six years of experience

• A doctorate or juris doctorate degree will count for seven years of experience

Note: Per the Job Application Fairness Act, you may redact information that identifies your age, date of birth, or dates of attendance at or graduation from an educational institution on your transcripts.

Preferred qualifications:

• Prior state experience in interpreting and applying state and federal regulations.

• Experience reviewing or submitting Health First Colorado claims.

• Experience using Microsoft Excel to conduct audits, make calculations, and/or general tracking.

• Experience developing internal procedures and managing government contracts.

• Experience participating in or supporting appeals, reconsiderations, or administrative review processes, AND experience drafting professional written communications such as audit notifications, corrective action letters, investigative findings, or compliance determinations.

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 EMPLOYMENT

• All 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.

• This is a term-limited position with funding through June 30, 2028. Successful candidates will sign a Waiver of Retention Rights and normal personnel rules regarding retention will not apply. Additional information regarding term-limited positions can be found here.

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.

Additional Information

How 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, Anupreet Kaur, at anupreet.kaur@state.co.us.

The Department of Health Care Policy & Financing does not offer sponsored visas for employment purposes.