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
The EVV Manager will be responsible for managing the EVV team, advising and informing DHP (Department of Health and Human Services) internal stakeholders of all policy changes, developments, and implementations, and ensuring regulatory and contractual compliance to policies. The ideal candidate must have MCO (Managed Care Organization) and STAR PLUS experience, as well as healthcare, analytical, auditing, and investigative experience. The candidate should also possess excellent data integrity, processing, and storage, assurance skills. Proficiency in SQL, Excel Macros, and statistical reporting is required. The candidate must be adaptable, flexible, and able to work in a fast-paced environment.
JOB SPECIFICATIONS AND CORE COMPETENCIES
Maintains utmost level of confidentiality at all times.
Manage the EVV team and ensure compliance with policies and procedures.
Adheres to Health System and Health Plan policies and procedures.
Develop and maintain regulatory and contractual compliance to policies.
Manage the EVV system to ensure accurate and timely documentation of services provided.
Develop and implement audit and investigative strategies to identify potential issues and ensure compliance.
Provides programming and querying expertise in the development of reports and routines for the use of data to meet organizational objectives.
Analyze and interpret data to identify trends, patterns, and issues related to EVV
Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
Provides effective leadership and fosters an environment that leads to collaboration, coordination, and integration between departments.
Advise and inform Community Health Choice internal stakeholders of all changes in EVV policies, developments and implementations.
Responsible for developing and maintaining regulatory and contractual compliance with all policies related to EVV.
Ensures the integrity of Community Health Choice data, including data extraction, processing, storage, manipulation, analysis and distribution.
Ability to take export data from disparate systems that do not interface, transform into usable formats and load into a usable data warehouse of their own creation.
Provide training and guidance to the EVV team to ensure compliance with policies and procedures.
Collaborate with internal stakeholders to identify and address EVV-related issues.
Monitor and evaluate the effectiveness of EVV policies and procedures.
Ensure timely and accurate submission of required reports and documentation.
Maintain heavy contact with EVV Providers which includes training, compliance and other misc. items.
Represent Community Health Choice in meetings and calls with vendors, providers, HHSC and other stakeholders.
Customer Service - Enthusiastically interacts with all customers. Assumes personal responsibility for meeting customer needs. Consistently demonstrates a commitment to customer satisfaction.
Interpersonal Skills - Is sensitive to the needs, ideas, and feelings of others. Develops and maintains rapport with others. Listens well. Facilitates a group process.
Adaptability/flexibility - Demonstrates the ability to change behaviors and plans to meet rapidly changing/ competing job demands (new or unusual situations). Receives change as a challenge. Revises plans to meet changing circumstances.
Communication - Clearly and effectively communicates ideas and requests to others. Persuades or influences others through spoken or written communication.
Initiative - Starts and completes tasks with minimum of prompting. Willing to make recommendations and assume additional responsibilities.
Team Player- Fully participates in maintaining a positive team environment that is conducive to customer satisfaction. Builds trust among co-workers, focusing on accomplishing hospital and departmental mission and goals.
Organized and efficient - Organizes work and uses time efficiently. Takes the initiative to find additional work during slow or downtimes. Recommends innovative ways of doing work more efficiently and effectively.
Core Values - Practices Community Health Choice core values.
Other duties as assigned.
Education/Specialized Training/Licensure: HS Diploma required. Bachelor degree in healthcare, business or related field with certification in analytics preferred.
Work Experience (Years and Area): Minimum of 5 years of experience in healthcare or related field; Minimum of 2 years of experience in EVV management required. Minimum of 5 years of experience in healthcare or related field; 3 years of experience in EVV management; Minimum 2 years in analytics preferred.
Management Experience (Years and Area): Four or more years supervisor/lead experience required. 5 years supervisor/lead experience preferred.
Software Proficiencies: SQL, Excel Macros, and statistical reporting experience. Certified in analytics and statistical reporting preferred.