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:

Serves as the initial support for the Eligibility department and delivers excellent customer service and meet both organization and state guidelines and requirements.  Assists Eligibility Analyst, Senior analyst, Supervisor and Director of Operations with all duties pertaining to member eligibility.

MINIMUM QUALIFICATIONS:
Education/Specialized Training/Licensure:  High School Graduate with two or more years of extensive experience within the medical field, preferably in the managed care and or Medicaid industry.  Extensive knowledge of the Medicaid Product and or CHIP products, Eligibility and Benefits.

Work Experience:  Two (2) or more years experience in a Health Care Call Center/Member Services Dept. with extensive group health insurance and Medicaid knowledge including but not limited to:  claims, eligibility, cob, benefits, value added and vendor benefits, state entities, requirements and regulations.



Skills:
Above Average Verbal (Heavy Public Contact)
Bilingual Skills Required   Languages:  Spanish preferred
Writing /Composing     (Correspondence/Reports)

Other Skills:
Analytical, Mathematics, Research, Statistical, P.C., MS Word, MS Excel   

Specialty: Multi-tasker with excellent mathematic and analytical skills

Work Schedule:  Flexible     

Other Requirements:  Excellent understanding of all CHC systems, able to use applications.

Application Instructions

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