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:   Responsible for the daily operations of the Claims Department, which includes but is not limited to, claims processing, payment, preparation and submission of regulatory deliverables, check run support, staff technical training, staff professional development, system configuration design recommendation, product implementation, writing policies and procedures and assisting with the development of departmental reference guidelines. Requires strong communication skills and proven management capabilities.

MINIMUM QUALIFICATIONS:

  •  Education/Specialized Training/Licensure: Bachelors degree required.
  •  Work Experience (Years and Area): 7 years in claims billing in health insurance or managed care environment.
  •  Management Experience (Years and Area): 7 years of direct supervision of staff experience in insurance or healthcare
  •  Software Operated: Microsoft Office (Word, Excel, Access, Outlook)


SPECIAL REQUIREMENTS: (Check Applicable Areas)

  • Communication Skills:
  • Above Average Verbal (Heavy Public Contact)
  • Writing /Composing: Correspondence / Reports
  • Other Skills: Analytical, Medical Terminology, Research, Statistical,
  •  Advanced Education: Bachelor¿s Degree Required
  • Work Schedule: Flexible


RESPONSIBLE TO: Vice President

EMPLOYEE SUPERVISED: Professional, Service and Clerical staff

 

Application Instructions

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