Provider Compliance and Oversight Specialist TERM LIMITED

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 role ensures Home and Community-Based Services (HCBS) providers and vendors comply with state and federal regulations, departmental standards, and fiscal requirements.

• Conduct financial compliance reviews of approximately 900 HCBS family caregivers and providers.
• Review supporting documentation (e.g., payroll records, timesheets, pay stubs, claims data) to assess compliance and identify overbilling or excess units.
• Calculate over payments and determine compliance or non‑compliance based on established thresholds.
• Communicate with impacted Medicaid provider agencies through 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.
• 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, including reviewing deliverables, procurement activities, and monitoring vendor performance.
• Conduct quality assurance reviews and process vendor invoices in compliance with State Fiscal Rules.

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

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 HCBS. Appropriate education substitutes for required experience on a year‑for‑year basis:

• Associate’s degree counts as 2 years of experience.
• Bachelor’s degree counts as 4 years of experience.
• Master’s degree counts as 6 years of experience.
• Doctorate or juris doctorate counts as 7 years of experience.

• Prior state experience interpreting and applying state and federal regulations.
• Experience conducting financial compliance reviews/audits.
• Experience conducting programmatic compliance reviews/audits.
• Experience reviewing or submitting Health First Colorado claims.
• Experience using Microsoft Excel, Smart Sheets, Salesforce, or other data dashboards for audits, calculations, and tracking.
• Experience managing government contracts.
• Experience participating in or supporting appeals, reconsiderations, or administrative review processes.
• Experience drafting professional written external communications related to compliance reviews or audits.

• This is a term‑limited position with funding through June 30, 2028; successful candidates will sign a Waiver of Retention Rights.
• All positions are security‑sensitive and require a criminal record background check.
• 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.

• PERA retirement benefits (PERA Defined Benefit Plan, PERA Defined Contribution Plan, 401K, and 457 plans).
• Medical, Dental, and Vision insurance coverage.
• Automatic Short‑Term and Optional Long‑Term Disability Coverage.
• L…