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: Manages, directs and organizes, the day-to-day operations of the Analytics staff.  Responsible for collection, aggregation, analysis and presentation of decision support tools for Community Health Choice.  Responsible for partnering with business departments to ensure required data for deliverables is accessible.  Maintains ticket request support system to ensure timely completion of request from business users.  Responsible for statistical analysis, reporting, and ad hoc querying of medical, financial and outcome data from various software databases.  Reviews, analyzes and evaluates data to determine trends, issues or opportunities for improvement in utilization, financial impact and/or operational systems.  Review data looking for outlying volume and/or financial issues.  Relies on extensive experience and judgment to plan and accomplish goals.  Performs a variety of tasks.  Responsible for meeting deadlines and managing multiple projects.  


MINIMUM QUALIFICATIONS:

1. Education/Specialized Training/Licensure:

  • BS required in Business, Healthcare Mgmt, Statistics, Mathematics or similar field

2. Work Experience (Years and Area):

  • 5 + years of experience in business performance reporting, data analysis and proactive insights.
  • Managed Care and Medical claims experience required. 
  • Familiarity with a variety of healthcare data including care coordination, claims, provider, account and call center data. 
  • Demonstrated experience enabling self-service in the business with tools such as Power BI

3. Management Experience (Years and Area):

  • 2+ years of experience leading data development and BI Teams.

4. Software Operated:

  • Microsoft Office (Word, Excel, Access and Outlook);
  • Strong Power BI, SQL Skills, SQL Server and Power BI;
  • Strong knowledge of Microsoft Azure, SSAS and data warehousing


SPECIAL REQUIREMENTS: (Check Applicable Areas)

1. Communication Skills:
Above Average Verbal (Heavy Public Contact)
Exceptional Verbal (e.g., Public Speaking)
Writing /Composing   (Correspondence  / Reports  )

2. Other Skills: Analytical, Mathematics, Statistical, MS Word, MS Excel,
MS Access

3. Advanced Education:

Bachelor's Degree Major: BS required in Business, Healthcare Mgmt, Statistics, Mathematics or similar field

4. Work Schedule :Flexible

5. Other Requirements:
Strong knowledge of T-SQL, databases and analytics to create meaningful insights from raw data.    Requires knowledge of medical terminology and coding, HMO concepts, practices and procedures, as well as financial concepts and statistical analysis.  Position also requires advanced technical skills in computer programming, database concepts, statistics and ad hoc query tools (i.e. SQL, Excel, etc.).  Ability to work independently.

RESPONSIBLE TO: Director

EMPLOYEE SUPERVISED: Professional (Exempt)

Application Instructions

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