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Medical Fee Strategist (Workers' Compensation) Job in Denver, Colorado

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Job Title: Medical Fee Strategist (Workers' Compensation)

Employer:Colorado Department of Labor and Employment, Division of Workers' Compensation
Type:Full-Time
Skills:coding,billing,auditing,communication,licensing,clinical,fee schedule,facility rates,policy,
Specialties:Payment policies, DRG coding, Sequencing and assignment of ICD-10, CPT, HCPCS, Policy management, clinical,
Required Certifications:CPC
Required Experience:3 to 4 years
Preferred Experience:5 to 7 years
Location:Denver, CO
Date Posted:11/6/2018

The Department of Labor and Employment keeps Colorado strong and competitive. We connect workers with great jobs and assist those who have been injured on the job. We help people who are unemployed through no fault of their own by providing temporary wage replacement and we ensure fair labor practices. We provide an up-to-date and accurate picture of the economy that helps in decision making. And we protect the workplace – and Colorado communities – with a variety of consumer protection and safety programs.
 
This is a values-driven organization, committed to teamwork, collaboration, accountability, adaptability, excellence, integrity and respect.
 
We believe in outstanding customer service, an inclusive culture, continued process improvement and in our role as a trusted and strategic partner. Recognizing that knowledgeable employees drive our success, we are seeking dedicated individuals who exhibit our shared values and our passion for quality and excellence in all we do.
 
In addition to rewarding and meaningful work, we offer excellent benefits:

 
Our agency website: Colorado Department of Labor and Employment
 
The State of Colorado is an equal opportunity employer.  We are committed to building work environments that are inclusive and reflect our communities and the diverse talents of all people.  We strongly encourage candidates from all backgrounds and abilities to apply.
 

Description of Job

Overall function of the work unit:
Section 8-42-101(3) of the Colorado Revised Statutes requires the Director of the Division of Workers' Compensation (Division) to develop utilization standards, which are promulgated in Rule 16 and to annually review the medical fee schedule, which is promulgated in Rule 18, in order to incentivize the most efficient provision of care.


Summary of the position: 
This position is a staff authority on healthcare payment policies and methodologies used for the Colorado Division of Workers' Compensation fee schedule. This position will be at the forefront of medical policy decision making and recommends policy positions and courses of action on annual rule revisions to upper management.  The work requires an individual that thoroughly understands fee schedule development and has a comprehensive understanding of the appropriate sequencing and assignment of ICD-10, CPT, HCPCS, as well as a thorough knowledge of DRG coding and hospital billing; the ability to work independently and collaboratively within a team environment; excellent communication skills; and the ability to engage a diverse group of stakeholders. In addition, this position provides guidance on rule interpretation to stakeholders, provides bill review assistance to internal staff, keeps management and staff apprised of current healthcare trends, and serves as a policy consultant on revisions to Rules 16 and 18. This position will lead additional initiatives to enhance payers' and providers' understanding of Division policy.  With this high impact position, you will grow as part of a division that is a national leader on Workers' Compensation policy.
 

Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights

MINIMUM QUALIFICATIONS:

Education and Experience:

Graduation from an accredited college or university with a bachelor's degree in a field of study related to the work assignment AND at least three years of full time professional experience developing a medical fee schedule, facility rates, or establishing medical policy.  
 
This experience must be substantiated within the Work Experience section of your application. "See Resume" will not be accepted. In addition, part-time work will be prorated.

Substitutions:
A combination of work experience in the health care or medical policy management field same kind, amount and level of knowledge acquired in the required education, may be substituted on a year-for-year basis. Additional appropriate education will substitute for the required experience on a year-for-year basis. 
                                 
Preferred Qualifications:
Knowledge of medical terminology, anatomy, and physiology.
Clinical degree, licensing or credentials.
Knowledge of Hospital Reimbursement guidelines.
Certified Professional Coder (CPC) from American academy of Professional Coders (AAPC). 
 
Conditions of Employment: 
Must be willing to relocate to Colorado. 
Must have (or obtain within 30 days of hire) and maintain a valid unrestricted Colorado Driver's License.
Must be able to lift 10 lbs.
Must be able to travel in state.
This position does not allow a teleworking option.
 


APPEAL RIGHTS:

If you receive notice that you have been eliminated from consideration for the position, you may protest the action by filing an appeal with the State Personnel Board/State Personnel Director within 10 days from the date you receive notice of the elimination.

Also, if you wish to challenge the selection and comparative analysis process, you may file an appeal with the State Personnel Board/State Personnel Director within 10 days from the receipt of notice or knowledge of the action you are challenging.

Refer to Chapters 4 and 8 of the State Personnel Board Rules and Personnel Director's Administrative Procedures, 4 CCR 801, for more information about the appeals process. The State Personnel Board Rules and Personnel Director's Administrative Procedures are available at www.colorado.gov/spb.

A standard appeal form is available at: www.colorado.gov/spb. If you appeal, your appeal must be submitted in writing on the official appeal form, signed by you or your representative, and received at the following address within 10 days of your receipt of notice or knowledge of the action: Colorado State Personnel Board/State Personnel Director, Attn: Appeals Processing, 1525 Sherman Street, 4th Floor, Denver, CO 80203. Fax: 303-866-5038. Phone: 303-866-3300. The ten-day deadline and these appeal procedures also apply to all charges of discrimination.

Supplemental Information

 
ADAAA Accommodations: Any person with a disability as defined by the ADA Amendments Act of 2008 (ADAAA) may be provided a reasonable accommodation upon request to enable the person to complete an employment assessment. To request an accommodation, please contact by phone or email at least five business days before the assessment date to allow us to evaluate your request and prepare for the accommodation. You may be asked to provide additional information, including medical documentation, regarding functional limitations and type of accommodation needed. Please ensure that you have this information available well in advance of the assessment date.
 
Minimum Qualification Screening
A Human Resources Analyst will only review the work experience/job duties sections of the online job application to determine whether you meet the minimum qualifications for the position for which you are applying. Cover letters and resumes WILL NOT be accepted in lieu of the official State of Colorado online application, but may be attached. Part-time work experience will be prorated.
 
Applicants must meet the minimum qualifications to continue in the selection process for this position. Work experience and qualifications must be specifically documented on your online application. Do not use "see resume" or "see attached" statements on your application. Resumes WILL NOT be reviewed for minimum qualification screening.
 
Comparative Analysis Process – Structured Application Review
After minimum qualification screening, the comparative analysis process for this position will involve a review and rating of all the information you submit with your application materials. Therefore, it is extremely important to document in the work experience/job duties portion of your online application the extent to which you possess the education, experience, minimum qualifications, and preferred qualifications as outlined in the job announcement. It is also important to thoroughly answer all supplemental questions (if listed) as your answers to these questions will be evaluated during this phase. Any attachments such as cover letters, resumes or other documents that support your experience may also be reviewed during this phase.
 
Supplemental Questions
Answer the supplemental questions on the application completely and thoughtfully. Your answers may be rated based on your writing ability (spelling, grammar, and clarity of your writing) as well as the content of your answer.


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