Compliance Support Specialist
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.
The Compliance Support Specialist will assist with all reporting required by regulatory bodies or vendors that involves Risk Adjustment, HEDIS and Fraud, Waste and Abuse (FWA) along with any internal reports to demonstrate efficacy of the program and internal controls. The primary responsibility of this role is to serve to support the centralized chart collections for HEDIS, RADV, Risk Adjustments and FWA as required by state and federal statute to ensure compliance with such. Additionally, this role oversees and facilitates the SIU recoupment process, development of articles for newsletters and other communications, and other special projects, as assigned. In addition, this role will serve in support of the team with scheduling of meetings and documenting of outcomes. This position supports Risk Adjustment and the Special Investigation team.
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.