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


The Provider Contract Coordinator establishes and serves as expert support for all Provider Contracts requirements for the organization. Organizes inventories and monitors all contracts for quality and accuracy. Ensures all contract requests are submitted to CONRAD and the appropriate Contract Analyst within one business day. Works with the request of the contract analyst that all contracts are sent to provider within 3 business days of request. Set-up and Maintain information for Network recruitment inclusive of research and coordination with the credentialing department. Ensure that no providers are loaded in MedMC as effective unless cleared by credentialing and the Board. Make sure all files in pending status are followed up in a timely manner indicated in the departmental policy and procedure. Utilize MedMC, Laser fiche and other CHC software tools. Ensure quality and completeness of information in files and loaded in laser fiche (W-9, correct agreement, TSA, correct effective dates etc.) Run reports timely and as requested by VP Network Management and Directors. Works collaboratively with coworkers to deliver member/provider expectations as evidenced by annual CHC Provider Satisfaction Survey scores of Overall Satisfaction with CHC/Health Plan. Delivers exceptional customer service by embracing ServiceFirst standards of behavior during all provider, member, visitor and staff encounters
Friendliness: Make eye contact and smile. Introduce yourself; offer assistance. Say the member/provider/coworker’s name often. Integrity: Ensure customers right to privacy and modesty. Do what you say you’ll do. Exceed expectations. Responsibility: Live Harris Health System and CHC’s mission. Be accountable. Take pride in your appearance and keep our facilities clean. Satisfaction: Say words like, my pleasure, and I’ll be happy to. Give everyone prompt service; keep them informed. Teamwork: Respect and encourage co-workers so our members/providers/visitors’ needs are met. Encourage co-workers and recognize them for a job well done.


MINIMUM QUALIFICATIONS:
BS or equivalent work experience in health care related field

A minimum of 2 year work experience in a health care related field. Knowledge of contracting.


Communication Skills:
Exceptional Verbal (e.g., Public Speaking)
Bilingual Skills Required? No
Writing /Composing (Correspondence/Reports)

Other Skills:
Analytical, Mathematics, Statistical, Typing wpm, P.C., MS Word, MS Excel, MS Access

Work Schedule:
Weekdays Monday thru Friday 8am - 5pm

Other Requirements: Diligent, accurate data entry, well organized, attention to detail. Familiarity with medical coding

Application Instructions

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