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
The Service Coordination Advocate at Community Health Choice is detail-oriented and proactive having a vital role in supporting the coordination of healthcare services for our STAR+PLUS members. This position provides administrative support to the Service Coordinator in managing service requests, scheduling, and rescheduling appointments, completing Health Risk Assessments, and ensuring the smooth operation of service delivery. The Service Coordination Advocate will handle a complexity of calls involving complex medical, behavioral health, and long-term care issues and LTSS SP waivers, which requires skilled professionals who can effectively assess needs, provide accurate information, and coordinate services. The Service Coordination Advocate collaborates with various internal departments, healthcare providers, and external stakeholders to ensure seamless service delivery and member satisfaction.

JOB SPECIFICATIONS AND CORE COMPETENCIES

  • Inbound Call Support:
  • Respond effectively and timely to inbound calls from STAR+PLUS members and providers regarding scheduling and rescheduling assessments, answering benefits and eligibility questions, claims processing status, and authorization status.
  • Conduct motivational interviewing when gathering supporting information from members or Legally Authorized Representatives (LAR) to ensure smooth operation of service delivery.
  • Handle a complexity of calls involving complex medical, behavioral health, and long-term care issues and LTSS SP waivers, which requires skilled professionals who can effectively assess needs, provide accurate information, and coordinate services.
  • Care Management System and Data Entry:
  • Maintain a working knowledge of the STAR+PLUS program, care management system (OICS), claim systems, and accurately enter required information into the designated Customer Relationship Management system (CRM) and the OICS system, adhering to departmental and organizational policies and procedures.
  • Collaborative Work with Internal Departments:
  • Work collaboratively with coworkers and internal departments (Medical Affairs, Member Services, Provider Services, Claims, and other internal groups) to deliver member/provider services that meet or exceed expectations.
  • Other duties as assigned



QUALIFICATIONS:

  • Education/Specialized Training/Licensure: High school diploma or equivalent required
  • Experience with the STAR+PLUS population, waivers, IDD programs, and Community First Choice (CFC) preferred.
  • Work Experience (Years and Area): Three (3) years of health care/plan experience, including call center experience and knowledge of pharmacy benefits, claims, and authorization status required
  • Proven experience in administrative roles, preferably in the healthcare or insurance industry.
  • Experience with call center phone applications (i.e., Avaya, NICE, Witness, Finesse, etc.) preferred.
  • Software Proficiencies: Call Center Phone applications (i.e. Avaya, NICE, Witness, Finesse etc.)



Job Family/Job Title Competencies

  • Problem Analysis
  • Attention to Detail
  • Critical Thinking
  • Responding Sensitively
  • Above Average Verbal
  • Exceptional Verbal
  • Writing /Composing


INTERPERSONAL SKILLS
Ensures all interactions are conducive to developing and maintaining a cooperative and productive working environment (both internally and externally).
Maintains self-control and conducts activities in non-adversarial manner.

Application Instructions

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