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 Risk Adjustment Coordinator will assist with all reporting required by regulatory bodies or vendors that involves Risk Adjustment and any internal reports to demonstrate efficacy of the program and internal controls. The primary responsibility of this role is to support the centralized medical record collections for RADV and Risk Adjustment as required by federal statute and ensure compliance. Additionally, this role supports the team with scheduling of meetings, documenting of outcomes, facilitates the development of articles for newsletters/other communications, and other special projects to support the Risk Adjustment team.

Essential Functions
*     Supports centralized chart gathering and submission process for compliance with federal and state governance.
*     Develop and maintain a tracking tool for records requests, follow up on requests for records, submission of invoices for payment, and follow up on invoices to meet the deadlines needed for projects.
*     Collaborates with teams regarding workflow process improvement, document management, and abstraction education.
*     Assists in communicating status updates, feedback, areas of improvements based on review strengths and weaknesses relating to tasks. Assist with the design and execution of projects to illustrate service and clinical quality improvement or opportunities for improvement within the organization, with Community stakeholders.
*     Assist in the preparations of internal and external meetings.
*     Maintain strong positive relationships with Community's leadership, other departments and delegated entities.
Special Projects: 
*     Responsible for completion of other duties and special projects as assigned.
*     Actively contributes to achievement of departmental goals, as identified in Department's annual business plan, including specific departmental process improvement plans.
*     Demonstrates Harris Health and Community Health Choice values, including trust, integrity, mutual respect, diversity, responsiveness, and caring service.
*     Other duties as assigned.


Education/Specialized Training/Licensure: 
*     High School Diploma or equivalent required.
*     Bachelor's degree preferred or equivalent work experience (Preferred, Healthcare, Business, Health, or related discipline) preferred.

Work Experience (Years and Area):

*     One (1) year healthcare experience with a degree.
*     3 or more years of experience without a degree required.
*     Clinical documentation improvement experience preferred.

Management Experience (Years and Area): N/A
2-5 years of management experience preferred.

Software Proficiencies: 
*     Microsoft Office (Word, Excel, Outlook) required.
*     Medical coding knowledge (ICD-10, HCPCS, and CPT)
Strong written and verbal skills. Strong interpersonal skills.
Solid knowledge of ACA, Medicaid, and Medicare preferred.

Application Instructions

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