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.

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: The Certified Medical Coder leads administrative/operational support tasks that require independent review and judgement relative to coding concerns. This position reviews claims data to ensure that assigned codes and supplies meet state, federal and health plan guidelines and conducts research including review of medical records that corresponds with the appropriate claims or medical management staffing personnel.

MINIMUM QUALIFICATIONS:

1. Education/Specialized Training/Licensure:

  • High school Graduate;
  • Certified Professional Coder (CPC) Certification required.
  • Certified Coding Specialist (CCS) Certification required.

2. Work Experience (Years and Area):

  • 5 years' coding experience with CCS certification required
  • Experience with a health plan or Third-Party Administrator preferred.

3. Management Experience (Years and Area): N/A
4. Software Operated: Microsoft Office (Word, Excel, Outlook)
5. Other Requirements: Excellent communication skills and the ability to interact with others effectively.

SPECIAL REQUIREMENTS: (Check Applicable Areas)

1. Communication Skills:
Writing /Composing: Correspondence / Reports

2. Other Skills: Analytical, Mathematics, Medical Terminology, Research, MS Word ,
MS Excel

3. Advanced Education:

Advanced Training Specialty: Certified Professional Coder (CPC) and Certified Coding Specialist (CCS) Certifications required.

4. Work Schedule: Flexible, Overtime

RESPONSIBLE TO: Supervisor/Manager

EMPLOYEE SUPERVISED: None

Application Instructions

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