Enrollment Data Specialist - 154250
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 Enrollment Data Specialist performs operational solutions to optimize membership enrollment and premium billing accuracy and collaborates and supports internal and external customers. This position researches and reconciles systemic eligibility/enrollment or premium billing /payment discrepancies to arrive at a consistently compliant disposition and operates in a fast-paced environment with frequent priority changes. The Enrollment Data Specialist is held responsible for understanding and abiding by State, Federal, and organizational guidelines for various lines of business related to Membership enrollment and reconciliation.
- High school diploma
- Knowledge of eligibility files /premium billing, Medicaid, Marketplace, Medicare preferred
- Two years related experience with health insurance, managed care, or customer service.
- Ability to work efficiently, pay strong attention to detail and deliver high quality results in a deadline driven environment, while effectively managing associated stress.
- Strong analytical, problem solving, organizational, prioritization and time management skills.
- Excellent interpersonal, verbal, written, and listening communication skills with a high level of comfort in recommending and implementing solutions.
- Mathematics, Medical Terminology, Research, Statistical
- Microsoft Office ( Word, Excel, and Outlook), SQL a plus
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.