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 Manager of Customer Service serves Members and Providers by maintaining departmental operations to include management of incoming calls related to claims payments, eligibility verification, as well as benefit interpretations; improving systems and processes; supports overall performance in meeting the state and federal guidelines and regulations; working with all levels of Leadership; developing and ensuring necessary staff education, and scripting the optimization of existing programs; defining service level targets for speed, efficiency, courtesy, and quality; managing staff to achieve service level targets and goals; and promoting culture that encourages and ensures Provider & Provider Call Center staff satisfaction.

JOB SPECIFICATIONS AND CORE COMPETENCIES

  • 20% Manages the daily operations of the Member and Provider Call Center functions including but not limited to hiring, training, motivating, and mentoring all departmental staff, conducts staff performance evaluations, scheduling, policies and procedures review and development, and ongoing process improvement.
  • 20% Maintains appropriate oversight and tracking of calls received to identify improvement opportunities, additional educational needs, or operational trends for 
  • focused departmental or organizational process improvement efforts.
  • 20% Monitors departmental activities, staff education and training to ensure compliance with all accreditation or regulatory requirements to ensure necessary staff skills to accomplish departmental objectives. Continuously review and improve as necessary staff education and training efforts to ensure materials are current, accurate and uniformly maintained and communicated to all pertinent staff - and to ensure continuous improvement in staff’s ability to respond timely and effectively to Provider and Memeber calls. Monitors random calls to improve quality, minimize errors, and/or evaluate performance.
  • 10% Supports the preparation and timely submission of departmental deliverables to meet organization accreditation and regulatory requirements. Meets or exceeds regulatory goals and requirements as well as internal benchmarks.
  • 10% Maintains appropriate disaster recovery and/or downtime protocols and actively engages with and participates in the ongoing direction and management of any third-party vendors critical to the Provider and Member Call center.
  • 10% Develops annual departmental goals and monitors expenditures to meet administrative cost targets.
  • 5% Effectively advances Community’s brand and promotes the organization throughout its markets and communities by serving as Board Member on, or as a significant volunteer (40 or more hours per year) for, community-based, governmental, industry, accreditation, provider, or business development entities whose purpose aligns with Community’s mission, or that impact community’s operational success or organizational sustainability.
  • 5% Actively contributes to achievement of departmental goals, as identified in Department’s annual business plan, including specific departmental process improvement plans


MINIMUM QUALIFICATIONS:   

Education/Specialized Training/Licensure:

  • BS or BA degree or four years of experience in lieu of degree

Work Experience (Years and Area):

  • 5 years in Health care, Quality monitoring, customer service, healthcare, preferable Managed Care

Management Experience (Years and Area):

  • Four or more years supervisor/lead experience

Equipment Operated: General office equipment

SPECIAL REQUIREMENTS:   

Communication Skills:

  • Above Average Verbal (Heavy Public Contact)  
  • Writing /Composing     Reports


Other Skills: 

  • CRT   Medical Terms                      
  • P.C.            MS Word       MS Excel   


Advanced Education:  Bachelor's Degree  Major: BS/.BA (preferred) 

Other Requirements:

  • Familiarity with medical coding and general claims payment rules and member cost-sharing. 
  • Strong customer service skills required.
  • Experience with telephone queue management


RESPONSIBLE TO:   Director

EMPLOYEES SUPERVISED:

  • Clerical Service       
  • Supervisory
     

Application Instructions

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