Senior Provider Engagement Representative - Community Health Choice - Provider Relations Division
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 Senior Provider Engagement Representative is field-based and is responsible for building and maintaining partnerships with Physicians, Hospitals, Ancillaries, and large or complex Physician organizations (Providers). Ensures consistent communication, support, and education to Providers on relevant topics, including but not limited to identified claims and/or authorization issues, new initiatives, availability and functionality of Community's Provider Portal. Primary lead for Joint Operating Meetings of assigned Providers. Serves as a subject matter expert in Community's incentive program(s); requests, analyzes and reviews provider-specific reports; offers alternatives and/or resolutions to undesirable report findings. Identifies and disseminates best practices within the Network and adheres to the Provider Communication and Interaction Guidelines. Collaborates with leadership, co-workers, and staff in other departments to achieve departmental and organizational objectives.
- Education/Specialized Training/Licensure:
- High School or equivalent required.
- BA/BS in Business preferred
- Work Experience (Years and Area):
- 5 years' experience in managed care (Provider Relations/Services; Claims Adjudication, Medical Coding, Contracting)
- Software Operated:
- Microsoft Office (Word, Excel, PowerPoint)
- QNXT and CACTUS system preferred
- Other Requirements:
- Must have valid driver's license and car insurance.
- Exhibit excellent communication and interpersonal skills by demonstrating solid verbal and written communication skills with internal and external customers ensuring that both oral and written communications are both constructive and professional at all times.
RESPONSIBLE TO: Director
EMPLOYEE SUPERVISED: None