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: Daily oversight and supervision of the Eligibility and Premium Billing team. Responsible for various tasks related to both enrollment and/or premium billing functions. Written and verbal interaction with internal and external customers related to research, audits, complaints, issues and grievance resolution. Responsible for reading, understanding and actively interpreting regulations from CMS, HHS, and other state and federal regulating agencies and its impact to billing and enrollment functions. Responsible for relationship development and collaboration with key stakeholders and third-party vendor

MINIMUM QUALIFICATIONS:

1. Education/Specialized Training/Licensure: High School Degree or GED
2. Work Experience (Years and Area): Five (5) years related experience in managed care, Member account management, eligibility file/premium billing experience. Bachelors degree maybe substituted for work experience. 
3. Management Experience (Years and Area): Six (6) months leadership/supervisory experience. 
4. Equipment Operated: Computer literate. MS Office (Excel, Word, Outlook)

SPECIAL REQUIREMENTS: (Check Applicable Areas)

1. Communication Skills: 
Above Average Verbal (Heavy Public Contact) 
Exceptional Verbal (e.g., Public Speaking) 
Bilingual Skills Required? No  
Writing /Composing Yes (Correspondence / Reports)

2. Other Skills:
Analytical 
Mathematics 

Medical Terminology
Research 
Statistical 
PC 
MS Word 
MS Excel

3. Advanced Education: 

4. Work Schedule
Flexible 

5. Other Requirements:
Possess a high level of critical thinking and problem solving. Have the ability to read and interpret different types of data efficiently. Have an ability to interpret CMS and HHS guidelines and legislation. Must possess intermediate skills using Microsoft office products such as Excel, Word and PowerPoint. Must have basic math skills and the ability to understand accounts receivables and billing cycles. Accounting knowledge is a plus.

RESPONSIBLE TO: Supervisor/Manager

 

Application Instructions

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