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.
JOB SUMMARY: The Enrollment Quality Assurance Analyst is responsible for end-to-end quality activities within the Operations Strategy Department (Enrollment and Reconciliation). The Enrollment Quality Assurance Analyst audits, evaluates, and scores the work performed by Enrollment team members. This role partners with Supervisors to communicate trends and the need for additional training, workflow, and or procedural changes. The Enrollment Quality Assurance Analyst provides feedback and coaching to the staff. All coaching sessions and skill development efforts will be documented and provided to Enrollment team members and submitted to leadership as needed. The Enrollment Quality Analyst is also responsible for some departmental training. The Enrollment Quality Assurance Analyst will work to ensure that employees are following the correct policies, procedures, and regulatory guidelines for their respective scope of work.
JOB SPECIFICATIONS AND CORE COMPETENCIES
Responsible for monitoring and evaluating enrollment files for all products within enrollment
Identifies knowledge gaps, performance trends and communicates observations to department leadership
Responsible for individual and/or group coaching for development in areas of opportunities identified
through trends or at the request of department leadership
Documents coaching discussions and submits to leadership as requested
Responsible for facilitating training based on performance trends or at the request of department
Education/Specialized Training/Licensure: High School Degree or GED or
equivalent, Associates preferred
Work Experience: Associates and Three (3) years relevant experience; or Five (5) years relevant experience in lieu of degree of which includes: eligibility or enrollment, quality monitoring, healthcare, managed care or insurance field.
Management Experience: N/A
Software Proficiencies: Microsoft Office (Word, Excel, Outlook)
Other: Bilingual: English/Spanish