Job Description

Community Health Choice, Inc. (Community) is a non-profit Health Maintenance Organization (HMO) licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 70 hospitals, Community serves over 260,000 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.

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:  Nursing Facility Configuration Analyst II will train and be a team lead in the Configuration Analyst I and applicable line staff.  Monitor and oversight the team to ensure works are allocated and meet the timeline.  Research, maintain, test and update QNXT configuration portal in order to ensure the accuracy of claims payment, authorization template, member, provider portal of the medical management system.  Support all departments and constant monitoring of the state and federal regulations to comply with the changes.  A bachelor degree is a plus but not mandatory.

 

The Nursing Facility Configuration Analyst II will train and be a team lead to the Configuration Analyst I and applicable line staff.  Monitor and oversight the team to ensure works are allocated and meet the timeline.  Research, maintain, test and update QNXT configuration portal in order to ensure the accuracy of claims payment, authorization template, member, provider portal of the medical management system.  Support all departments and constant monitoring of the state and federal regulations to comply with the changes.  It is imperative that individual have knowledge of the healthcare industry and experience with QNXT or similar claims processing applications.  A bachelor’s degree is a plus but not mandatory.

MINIMUM QUALIFICATIONS:

Education/Specialized Training/Licensure: High School Graduate or Equivalency required,
 BS or BA preferred.
Work Experience (Years and Area):  
•    5 years Healthcare Industry experience, 
•    3 years QNXT experience or similar claims processing applications.  
Preferred Skills:
•    QNXT Foundations Training, 
•    QNXT Specialist Certification or any other claims processing application certification is highly preferred.
•    Texas Medicaid and CMS experience preferred.

SPECIAL REQUIREMENTS: 
Communication Skills:  Above Average Verbal (Heavy Public Contact), Writing /Composing, Reports.
Other Skills:  CRT, Medical Terms, P.C.,  MS Word, MS Excel
 

Application Instructions

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