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: The Coordination of Benefits Analysts is responsible for using established methods to investigate, verify, and record other coverage information.  This position is responsible for researching potential dual coverage and investigation of other coverage.  Reviewing claims history, identify impacted claims based on findings, routing to adjustments or refunds. The COB Analyst will document coordination of benefits information into applicable database/system and respond to inquiries and correspondence related to coordination of benefits between Community Health Choice and other Payors.   (Entry level with Preferred skills - Coordination of benefits)

MINIMUM QUALIFICATIONS:
1. Education/Specialized Training/Licensure: High School Diploma, GED or Equivalent
2. Work Experience (Years and Area): Two (2) years - claims payment or coordination of benefits experience
5. Software Operated  Microsoft Office Suite


Other Requirements:

  •  Background in government and/or commercial insurance healthcare coverage is a plus Computer literate and basic knowledge of claims software usage.
  • Basic knowledge of medical procedures and terminology, medical CPT, ICD-10, DRG and Healthcare Common Procedure Coding System (HCPCS).


SPECIAL REQUIREMENTS: (Check Applicable Areas)

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

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


RESPONSIBLE TO: Supervisor/Manager

 

Application Instructions

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