STAR+PLUS Configuration Analyst I
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: Research, maintain, test and update application configuration in order to ensure the accuracy of operational processes within the system based on business requirements. Analyze and resolve configuration issues in a timely manner. Support and collaborate with all departments. Constant monitoring of the state and federal regulations to comply with the changes. Review application release notes and related change documentation to determine potential impacts on existing business processes supported within the application.
Configuration Contract/Benefit Analyst: Perform complex analysis, testing, proof of concept, communication, documentation and implementation of daily contract / benefit configuration review. Provide status, feedback, and suggestions in internal meetings. Design, develop and implement projects/products and configuration to meet CHC business objectives.
Configuration Provider Analyst: Responsible for the accurate and timely update of all, provider data into the credentialing and claims database in accordance with departmental policies, procedures and metrics. Facilitates the Provider Data Attestation and claims resolution process.
1. Education/Specialized Training/Licensure: High School Graduate or GED.
2. Work Experience (Years and Area): 3 years Health Care industry experience or application configuration support experience.
3. Management Experience (Years and Area): N/A
4. Software Operated: Microsoft Office (Word, Excel, Outlook)
Above Average Verbal (Heavy Public Contact)
Bilingual Skills Required? No
Writing /Composing: (Correspondence / Reports )
Other Requirements: Strong written and verbal communication skills. Strong analytical and reporting skills. Diligent, accurate data entry, well organized, attention to detail
RESPONSIBLE TO: Supervisor/Manager
EMPLOYEES SUPERVISED: None
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Job Status: Full Time
Job Reference #: 166858