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

The Provider Data Integrity Analyst understands end-to-end master data process flows and uses knowledge to ensure timely processing, validation and submission of all required Network Management reporting such as Key Metrics Reporting and State Deliverables, working with Analytics and Network Management leadership to update metrics and reporting templates.  Provides business process, system support and data quality governance for master data through data coordination and integration to ensure efficient processes and consistent data flows to business and stakeholders.  Accountable for maintaining the contract management system.

 QUALIFICATIONS:

  • Bachelor's degree preferred.
  • Three years analytical and reporting experience with degree.
  • Seven years' related healthcare experience in lieu of degree.
  • Contracting, Claims and Credentialing knowledge a plus.

OTHER SKILLS:

  • Writing /Composing: Correspondence/Reports
  • Analytical, Mathematics, Medical Terminology, Statistical
  • MS Word, MS Excel



 

Application Instructions

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