Encounter Data Specialist (CHC)
Community Health Choice, Inc. (Community) is a non-profit Health Maintenance Organization (HMO) licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 70 hospitals, Community serves over 260,000 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 Encounter Data Specialiat position in the Performance Excellence Department (Quality Department) with the Risk Adjustment Team which is responsible for overseeing the accuracy, timeliness and completeness of Communitys Risk Adjustment data for its Marketplace line of business. The Specialist will assist with any reporting required by regulatory bodies or vendors that involves risk adjustment along with any internal reports to demonstrate efficacy of the program and internal controls. Along with the Risk Adjustment Team, the Specialist must maintain a continuous quality improvement focus for the department and within Community and actively participate in other committees/workgroups as assigned. The Risk Adjustment Specialist will be responsible for compiling, verifying, and analyzing data for trend and other analyses related to Risk Adjustment. This person will be collecting and analyzing healthcare related encounter and member eligibility data by performing data management and quality improvement studies on that data and producing the resulting reports. The Specialist will develop expert knowledge of the Center for Medicare and Medicaid Services (CMS) risk adjustment model, its concepts and methodology in order to reconcile CMS and vendor-provided risk score reports.
Other Requirements: Ability to manage complex projects across multiple departments, critical thinking skills. Strong problem-solving, quantitative and analytical skills. Ability to use business intelligence query tools, computer spreadsheet (Excel), and database (Access and others, including Visual Basic) at advanced level., Working knowledge of Structured Query Language (SQL) and Extensible Markup Language (XML). Knowledge of Risk Adjustment reporting and analysis. Proven skills in report writing and report development. Dashboard development skills a plus. Proven skills with data presentation including charts, graphs and other exhibits. Ability to communicate effectively both orally and in writing. Ability to handle multiple responsibilities and changing priorities. Ability to quickly learn and implement knowledge of new technical processes. Must pay attention to details. Excellent organizational skills
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.