Director, Provider Relations - 155032
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.
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.
The Director, Provider Relations is responsible for the day-to-day supervision of the Provider Relations staff and day-to-day management and oversight of the operations of the Provider Relations Department, including, but not limited to; (1) maintenance of Community's formal Provider Education Plan, annual revisions and execution of Provider Incentive Programs and improvement of the Provider Satisfaction Survey results, (2) timely and efficient general communication with participating providers, (3) timely and efficient resolution of general provider inquiries and/or complaints, (4) collaboration with staff from other health plan departments as it relates to maintenance of Community's provider networks from an Access/Availability and competitive standpoint, (5) identifying and implementing innovative means to improve provider engagement and overall performance, and (6) compliance with all local, state and federal laws and regulations, obligations set forth by HHSC and CMS, as well as any accreditation standards prescribed by NCQA and URAC.
- BA in Business/Marketing or related field preferred;
- Four years equivalent work experience may substitute for degree requirement.
- Seven years of experience and training in Provider Relations; claims adjudication, contracting, and/or physician practice
- Five years of experience in management role, preferably in Claims, Provider Relations, and/or Contracting department.
- Working knowledge of provider community & various healthcare delivery systems
- Above Average Verbal (Heavy Public Contact)
- Writing /Composing (Correspondence /Reports)
- MS Word
- MS Excel
Benefits and EEOC
Community employees’ benefits are provided by Harris Health. These benefits are designed to provide you with flexibility and choices in meeting your specific needs.
Community is an Equal Opportunity Employer.