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:

We are looking for a Customer Enrollment Supervisor. Daily oversight and supervision of the Eligibility and Premium Billing team. Responsible for various tasks related to both enrollment and/or premium billing functions. Written and verbal interaction with internal and external customers related to research, audits, complaints, issues and grievance resolution. Responsible for reading, understanding and actively interpreting regulations from CMS, HHS, and other state and federal regulating agencies and its impact to billing and enrollment functions. Responsible for relationship development and collaboration with key stakeholders and third party vendor.

Roles and Responsibilities:

  • Team Productivity- Timely completion for all designated work assignments including call tracking, Navitus updates, payment processing, quality assurance audits, data warehouse queue task assignments, and ensures month end close is with less than 10% of total manual entries. Responsible for employee development Coaching, team meetings, huddles and department rewards and recognition plan. Identify and participate in Employee development plans.
  • 20% Compliance- Applies CMS rules and regulations as applicable to enrollment and payment process. Applies local, state, and federal rules and regulations in reference to subsidies for applicable accounts. Remains knowledgeable and applies applicable APTC guidelines for payment processing for applicable accounts. Applies eligibility and enrollment guidelines to all accounts for account level accuracy (e.g., termed/active). Partners with training department to ensure that training is developed and delivered following applicable local, state, and federal guidelines.
  • 20% Quality Assurance-Development and implementation of a Quality Review audit process. Completes designated number of audits per employee per month. Track and trend areas of deficiencies to develop strategies for improvement.
  • 10% Change Management- Streamline work processes. Identify work efforts that are obsolete and make recommendations for load balancing to correct department and/or third-party vendor. Review, identify, and execute plan for automation of work efforts leading to greater capacity at the employee level.
  • 10% Creates and delivers department reports including: All items received for processing (enrollment/payment processing). All items processed. Average Turnaround time for processing. Calculates percentage completed by the department. Captures OT month-over-month. Quality Review Average for the department. Develops and delivers employee level reporting.
  • 10% Actively contributes to achievement of departmental goals, as identified in Department’s annual business plan, including specific departmental process improvement plans and other duties as assigned.

MINIMUM QUALIFICATIONS:

Education/Specialized Training/Licensure:

  • High School Degree or GED

Work Experience :

  • Five (5) years related experience in managed care, Member account management, eligibility file/premium billing experience. Bachelor's degree maybe substituted for work experience.

Management Experience (Years and Area): Six (6) months leadership/supervisory experience.
Equipment Operated: Computer literate. MS Office (Excel, Word, Outlook)

Preferred knowledge of enrollment files and reporting for Medicaid ( STAR/CHIP, STAR PLUS) and Medicare ( DSNP)

SPECIAL REQUIREMENTS:

Communication Skills:

  • Above Average Verbal (Heavy Public Contact)
  • Exceptional Verbal (e.g., Public Speaking)
  • Writing /Composing Yes (Correspondence / Reports)

Other Skills:

  • Analytical
  • Mathematics
  • Medical Terminology
  • Research
  • Statistical
  • PC
  • MS Word
  • MS Excel

Work Schedule
Flexible

Other Requirements:
Possess a high level of critical thinking and problem solving. Have the ability to read and interpret different types of data efficiently. Have an ability to interpret CMS and HHS guidelines and legislation. Must possess intermediate skills using Microsoft office products such as Excel, Word and PowerPoint. Must have basic math skills and the ability to understand accounts receivables and billing cycles. Accounting knowledge is a plus.

RESPONSIBLE TO:
Supervisor/Manager

Job Type: Full-time

Pay: $55,000.00 - $75,000.00 per year

Benefits:

 

  • 401(k)
  • 401(k) matching
  • Dental insurance
  • Disability insurance
  • Employee assistance program
  • Employee discount
  • Flexible schedule
  • Health insurance
  • Health savings account
  • Paid time off
  • Paid training
  • Parental leave
  • Tuition reimbursement
  • Vision insurance

 

Schedule:

 

  • 8 hour shift
  • Monday to Friday

 

Experience:

  • Microsoft Office: 1 year (Preferred)
  • Sales: 1 year (Preferred)

Ability to Commute:

  • Houston, TX 77081 (Preferred)

Ability to Relocate:

  • Houston, TX 77081: Relocate before starting work (Required)

Work Location: Hybrid remote in Houston, TX 77081

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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