Managed Care Rates & Reconciliation Analyst

Due to the State’s current hiring freeze, this position will not be filled until after January 1, 2026STATE OF COLORADO RESIDENCY REQUIRED AT TIME OF APPLICATIONNOTE: This announcement may be used to fill multiple openings.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 oversees and operates (Colorado’s Medicaid Program), (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 looking for a Managed Care Rate & Reconciliation Analyst to join our Managed Care Rates HMO Rates Unit!As part of the State of Colorado, HCPF offers aretirement benefits including PERA Defined Benefit Plan, PERA Defined Contribution Plan, plus 401K and 457 plans, , and insurance coverage(FSAs)job protection and State of Colorado Paid Family Medical Leave (PFML)Accrued 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-LifeFree to all eligible State EmployeesMembership EligibilitySome positions may qualify for the Public Service Loan Forgiveness Program. For moreinformation, go to .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. What you’ll be doing:Position supports the capitation rate development for the Health Maintenance Organizations (HMOs), Children Health Plan Plus (CHP ) and Program for All-Inclusive Care for the Elderly (PACE) program with the following responsibilities:

• This position uses database software to extract, compile and interpret data.
• Develops and completes a range of analyses and reports using statistical measures or under instruction from other senior analysts. Using transaction record analysis, including SQL based database extracts and statistical techniques, position produces summarized reports.
• Reviews the federal and state regulation changes to ensure the HMOs, CHP , and PACE program comply with any relevant changes. The position will work with stakeholders to communicate changes or collect necessary deliverables to meet the regulation requirements.
• Collaborates and coordinates different projects in other areas (such as accounting, budget, interchange system, program policy team and others) in the Department to ensure the program operations run smoothly.
• Performs quality reviews and provides statistical analysis support for all the programs. Position research eligibility information which forms the basis for identifying actuarially equivalent populations.
• Reviews financial data submitted by the managed care entities, determines its validity and correctness, and makes recommendations regarding any necessary wrap around payments and capitation reconciliations.

Residency Requirement:This posting is only open to residents of the State of Colorado at the time of submitting your application.Class Code & Classification Description: (New)
H8G4XXMINIMUM QUALIFICATIONS: Experience Only:Six (6) years of relevant experience in State and Federal managed care policies, Budgeting, Data analysis, Data manipulation using Excel OREducation and Experience: Bachelors in Economics, Mathematics, Statistics, Data Science, Finance, Public Health, or other related AND
Two (2) years of experience in State and Federal managed care policies, Budgeting, Data analysis, Data manipulation using ExcelAppropriate education will substitute for the required experience on a year-for-year basis. Relevant education will be calculated as the following:An associate will count as two years of experienceA bachelors will count as four years of experienceA masters degree will count for six years of experienceA doctorate or juris doctorate degree will count for seven years of experiencePreferred Qualifications & Special Qualifications:Master’s degreeIntermediate SQL or other database experienceIntermediate to expert level in ExcelExperience in Tableau, SAS, or other statistical and visualization packagesExperience interpreting State and Federal regulationsManaged Care experienceDEFINITION 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.Appeal Rights: (Updated)An applicant who has been removed from an employment list or removed from consideration during the selection process may request a review by the State Personnel Director.As an applicant directly affected by the results of the selection or comparative analysis process, you may file a written appeal with the State Personnel Director.Review of the completed, signed and submitted appeal will be timely on the basis of written material submitted by you, using the official appeal form signed by you or your representative. This form must be completed and delivered to the State Personnel Board by email at within ten (10) calendar days from your receipt of notice or acknowledgement of the Department’s action.
For further information on the Board Rules, you can 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 .(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 ProcessThe 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, Minnie Kaur, at .The Department of Health Care Policy & Financing does not offer sponsored visas for employment purposes.

State of Colorado