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 providing support for the network development  contracting process. Organizes contract inventories and verifies that all required documents are received from providers and complete. Ensures all contract requests are submitted in internal systems, and to the appropriate Provider Contract Specialist or Senior Provider Contract Specialist within defined internal timeframe or regulatory requirement. Route signed provider contracts through defined approval process. Arrange and maintain information for network recruitment, inclusive of network adequacy requirements designated by regulatory agencies, which may include prospecting and outreach to prospective network providers. Following monthly MCMC meeting, forward Welcome Packet and executed agreement to providers within defined timeframe and submit to Payment Solutions team for loading. 
Ensure all provider files in pending status are followed up in a timely manner indicated in the departmental policy and procedure. Prepare provider termination forms, program adds, and demographic changes and submit to Payment Solutions within defined regulatory timeframes. Confirm quality and completeness of information in files (for example, W-9, contracts, correct effective dates etc.) and loaded in appropriate internal systems.

Reports to Position Title: Manager, Senior Manager


Required :Education/Specialized Training/Licensure: High School Diploma or Equivalent
Work Experience (Years and Area): 1 year relevant work experience 

Software Proficiencies: Microsoft Office (Word, Excel, Outlook)
Other: Must Have Vehicle and Valid State of Texas Driver’s License; Experience with Star Plus, LTSS, HCBPs, and Medicare products a plus

Organizational Core Competencies: All employees are responsible for understanding and demonstrating Community Health Choice core competencies:
• Customer Focus – Sustainability 
• Reliability and Dependability – Employee Empowerment 
• Honesty & Integrity – Sustainability 
• Achievement Orientation – Sustainability 
• Change Management – Affordability 
• Team Work – Employee Empowerment 
• Impact & Influence + Strategic Vision – Profitable Growth (Supervisory Employees)
• People and Team Development – Employee Empowerment (Supervisory Employees)

Job Family/Job Title Competencies:

  • Attention to Detail
  • Critical Thinking
  • Thoroughness
  • Taking Initiative
  • Accuracy
  • Sense of Urgency
  • Customer Oriented
  • Planning and Organizing
  • Flexibility



Application Instructions

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