Job Description

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

* Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women

* Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR

* Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.

* Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

Skills / Requirements

JOB SUMMARY:
Responsible for understanding the business and business requirements in relation to applications / systems, reporting, and processes.  Research system / application issues, recommends solutions, and coordinate system / application modifications to correct issue. Works with business units to clarify new requests and interpret needs.   Provides functional system /application knowledge. The job includes significant or complex system configuration, process design, data analysis and issue resolution.

Job Responsibility and Core Competencies: 

Provides internal ad-hoc reports in a manner that is accurate, timely and consistent. Write queries, views, tables, stored procedures, and schedule jobs in SQL Server 
Management Studio based on user specifications. Develop automated reports and schedule subscriptions using SQL Server Reporting Services and Microsoft Power 
BI. Create and maintain tabular models using SQL Server Analysis Services to facilitate enterprise reporting.

Utilize statistical models (CDPS, CMS Risk Adjustment, 3M) to identify trends in utilization and performance over time. Utilize geographic information system tools 
(e.g. ArcGIS, Quest Analytics) to perform network adequacy and spatial analyses. Review, analyze, and evaluate financial, medical, and member data to determine 
trends, issues, or opportunities for improvement. Perform statistical analyses to develop recommendations to business owners that improve workflows, processes, 
and compliance. Educate departments on current business processes and their effects on reported measurements. 

 Actively contributes to achievement of departmental goals, as identified in Department’s annual business plan, including specific departmental process improvement plans. 

MINIMUM QUALIFICATIONS:   

Education/Specialized Training/Licensure: 
*     Bachelor’s degree in business, Information Technology, Computer Information Systems, Systems Engineering, 
*     related fields or four (4) years of related work experience may substitute for the bachelor’s degree.
Work Experience (Years and Area): 
*     2 years of experience in information systems. 

SPECIAL REQUIREMENTS:  
Communication Skills:
*     Above Average Verbal 


Work Schedule:   Flexible

Other Requirements: Knowledge:
 Knowledge of technical and business analysis.  
*     Knowledge of Microsoft technologies, troubleshooting application issues and errors with SQL Server experience.
*     Knowledge of the healthcare industry in general and specifically of the health insurance environment is preferred.
*     Familiarity with a variety of hardware and software environments.
*     Knowledge of T-SQL and database designs
*      Process mapping.
Skills:
*     Perform troubleshooting and recommend appropriate action.
*     Apply application analyst techniques.
*     Develop and run T-SQL basic queries.
Written and verbal communication
*     Microsoft Office suite, with strengths in Excel, Word, and Visio
*     Preferred Skills:
*     Report Development
*     Web Browser Settings
*     Microsoft SharePoint
*     Microsoft Team Foundation.

RESPONSIBLE TO: 
Manager
 

Application Instructions

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