Medical Dispute Resolution Specialist

Salary : $57,708.00 - $81,432.00 Annually

Location : Statewide, CO

Job Type : Full Time

Job Number : KAA 9651 CIS II 2.25

Department : Department of Labor and Employment

Division : Division of Workers' Compensation

Opening Date : 02 / 12 / 2025

Closing Date : 2 / 21 / 2025 5 : 00 PM Mountain

FLSA : Determined by Position

Type of Announcement : This position is open only to Colorado state residents.

FLSA Status : Non-Exempt; position is eligible for overtime compensation.

Department Contact Information : chris.mcgill@state.co.us

Primary Physical Work Address : 633 17th Street, Denver, CO 80202, however this position is intended to be primarily remote.

How To Apply : Please submit an online application for this position at Reach out to the Department Contact to apply using a paper application, including any supplemental questions. Failure to submit a complete and timely application may result in the rejection of your application. Applicants are responsible for ensuring that application materials are received by the appropriate Human Resources office before the closing date and time listed.

Department Information

THIS POSITION IS OPEN TO CURRENT RESIDENTS OF COLORADO ONLY

THIS ANNOUNCEMENT WILL REMAIN OPEN UNTIL 5 : 00 PM ON FRIDAY, FEBRUARY 21. 2025

This position is intended to be 100% remote but may still be required to report to a selected state office due to business need or at the discretion of the supervisor.

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 accountability, agility, collaboration, 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 :

• Strong, secure, yet flexible retirement benefits including a PERA Defined Benefit Plan or PERA Defined Contribution Plan plus 401(k) and 457 plans
• Medical and dental health plans
• Employer supplemented Health Savings Account
• Paid life insurance
• Short- and long-term disability coverage
• 11 paid holidays per year plus vacation and sick leave
• BenefitHub state employee discount program
• MotivateMe employee wellness program
• Excellent work-life programs, such as flexible schedules, training and more
• Access to participate in employer-supported employee affinity spaces
• RTD EcoPass Commuter Program
• Some positions may qualify for the Public Service Loan Forgiveness Program. For more information go to

Our agency website : Colorado Department of Labor and Employment

CDLE has implemented a pilot program on March 1st, 2022 which will award Disability Hiring Preference Points similar to the Veterans' Preference Points program. During your application process you will be asked if you would like to be considered for either of these programs for additional points in the hiring process. To learn more about Disability Hiring Preference and what will be required to participate, please visit our website :

PLEASE NOTE : With the beginning of this program, CDLE will no longer accept attachments of any kind with applications. Please be as thorough as possible in documenting your education and work history in the application system. Attachments will not be accepted or considered during any phase of the hiring process including minimum qualification screening, comparative analysis, or interviews.

Description of Job

The salary range for this posting is :

HOURLY

27.74 - $39.15

BIWEEKLY

2,219.54 - $3,132.00

MONTHLY

4,809.00 - $6,786.00

ANNUALLY

57,708.00 - $81,432.00

This position is fully operational at handling medical billing and Rule violation disputes that come into the unit through the Medical Dispute Resolution (MDR) process. Annually the unit handles approximately 1,000 -2,000 cases. This requires a working knowledge of Rules 11, 16, 17 and 18, as well as a comprehensive understanding of billing practices and proper use of CPT® (Current Procedural Terminology) codes. This position is responsible to review the details of the submitted case in their entirety and determine if a Rule violation has occurred. Judgment is needed in locating and selecting the most appropriate of these Rules, if applicable, which may be different for each case. When no Rule violation has occurred, courses of action may include recommendations and / or education to one or both parties in an attempt to facilitate a voluntary agreement.

As part of the MDR process, this position audits insurance carriers' and self-insured employers' (insurers) medical bill payments for compliance with the Act and Rules 11, 16, 17 and 18. Position analyzes data, issues formal findings, negotiates agreements and issues final reports with summaries of deficiencies. Provides recommendations to management based on audit findings to aid in the development of follow-up action and future policy decisions. These duties require working knowledge of Rules 11, 16, 17 and 18, a comprehensive understanding of billing practices and the ability to work within pre-established timeframes and effectively communicating with payers, providers and unit staff. This duties also require a comprehensive understanding of the proper application of CPT, RBRVS (Resource Based Relative Value System), APCs (Ambulatory Payment Classifications), MS-DRGs (Medicare Severity Diagnosis Related Groups), AWP (Average Wholesale Price), DMEPOS (Durable Medical Equipment, Prosthetics / Orthotics and Supplies) pricing, and the ability to perform mathematical calculations.

Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights

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 :

H6J3XX

MINIMUM QUALIFICATIONS :

Experience Only :

Five (5) years of relevant experience in an occupation related to the work assigned to this position to include : medical billing, bill review / adjusting, and / or medical bill auditing.

Education and Experience :

A combination of related education and / or relevant experience in an occupation related to the work assigned equal to five (5) years.

Preferred Qualifications :

Competencies :

Conditions of Employment :

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 dpa_state.personnelboard@state.co.us 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, atspb.colorado.gov / board-rules.

Supplemental Information

For questions regarding this recruitment, please contact : chris.mcgill@state.co.us

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, CDLE does not accept attachments of any kind during the application process. 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. CDLE does not accept attachments of any kind during the application process.

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.

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.

THIS ANNOUNCEMENT MAY BE USED TO FILL MULTIPLE AND / OR FUTURE VACANCIES

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 Colorado Department of Labor and Employment 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, Sean Montoya, at sean.montoya@state.co.us. Auxiliary aids and services are available upon request to individuals with disabilities. For all other inquiries about this recruitment effort, please call 303-318-8200.

While a salary range is posted for this position, an eventual salary offer is determined by a comprehensive salary analysis, which considers multiple factors including but not limited to education and experience compared to others in the organization doing substantially similar work.

The State of Colorado offers permanent employees a variety of benefits including medical, dental, life and disability insurance, as well as a comprehensive leave program. Please click the following link for detailed information :

Please note that each agency's contact information is different; therefore, we encourage all applicants to view the full, official job announcement which includes contact information and class title. Select the job you wish to view, then click on the "Print" icon.

I acknowledge the comparative analysis process for this position will consist of a review of the information contained within my application / job duty statements and that any attachments will not be included during the minimum qualification screening or application review. The structured application review / numerical scoring of my application will be based on the content listed in the job duty statements, the preferred qualifications, required competencies, and answers to supplemental questions. My responses to the supplemental questions will be scored based on my ability to follow instructions and provide detailed, clear and concise answers to each question.

Describe a difficult billing dispute you encountered in the course of your professional experience with medical claims and how you resolved it.

A provider's office supplies 2 feet of yellow Theraband and 5 feet of green Theraband to an injured worker for a home exercise program. The fee schedule allows reimbursement at 120% of cost, as demonstrated by invoice, for take home exercise supplies. The provider submits a bill to the insurance carrier for $12.06 with a copy of the invoice. The invoice states : Theraband 50 yard, Dispenser Box, Level 1 Yellow, Thin $58.78Theraband 50 yard, Dispenser Box, Level 2 Red, Medium $61.86Theraband 50 yard, Dispenser Box, Level 3 Green, Heavy $70.07Theraband 50 yard, Dispenser Box, Level 4 Blue, Extra Heavy $77.04If applying the fee schedule, how much reimbursement does the insurance carrier owe the provider?

What is the Ambulatory Payment Classification for CPT code 63005, what is the status indicator for that code, and what does that status indicator mean? Please include where you found this information.

Required Question

Salary : $4,809 - $6,786