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:   This position manages the oversight of enrollment activities for the organization's Affordable Care Act and Medicaid/CHIP capitated health plan lines of business through ensuring policies and procedures are followed and quality performance metrics are met.  The manager is responsible for developing productivity standards and quality/training programs as well as creating department policy and procedures to support enrollment, premium billing and quality assurance activities.  Duties include but are not limited to the following:  (1) managing the activities of Member Database Coordinators and Analysts, Premium Billing Coordinators, Team Lead and Supervisors, (2) ensuring productivity standards and quality/training programs are being followed and contractual requirements are met, (3) generating reports to ensure performance expectations and production the enrollment/billing teams are meeting standard, and performs counseling/coaching as needed. 

MINIMUM QUALIFICATIONS:   

  • Education/Specialized Training/Licensure: High school diploma or GED; Bachelor degree in Business, Accounting preferred
  • Work Experience (Years and Area): 7 years related experience in high volume operations, to include call center, data processing center, healthcare operations
  • Management Experience (Years and Area): 5 years supervisory/managerial experience
  • Software Operated: Microsoft Office (Word, Excel, Outlook)


SPECIAL REQUIREMENTS:  

  • Communication Skills:  Writing / Composing, Correspondence /Report
  • Other Skills:  Analytical,  Medical Terms   
  • Work Schedule:   Flexible

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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