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 Senior Enrollment Analyst is responsible for the analysis, monitoring, reporting, data exchange and assurance of operational compliance for the Community Health Choice plan products. Serves as a subject matter expert accountable for maintaining an ongoing assessment and interpretation of regulations pertaining to Member eligibility determination and reconciliation. This position will research, track and resolve complex issues related to enrollment discrepancies, reconciliation, technical problems, regulatory guidelines and timelines to arrive at a consistently compliant disposition. The Senior Enrollment Analyst will directly respond or support a response that is rapid and professional to internal and external customers. The senior analyst will have knowledge and understanding of all lines of business, collaborating with various business areas.
MINIMUM QUALIFICATIONS:
- Education/Specialized Training/Licensure:
- HS diploma required,
- Bachelor's degree from an accredited college or university preferred.
- Work Experience (Years and Area):
- Five (5) years health related experience with health insurance, managed care, or healthcare related organization required.
- Two (2) years of analysis, research, and/or project management experience preferred.
- Management Experience (Years and Area): N/A
- Software Operated: Microsoft Office (Word, Excel, and Outlook), EAM platform is a plus.
SPECIAL REQUIREMENTS:
- Communication Skills:
- Above Average Verbal (Heavy Public Contact)
- Writing/Composing: Correspondence/Reports
- Other Skills: Analytical, Mathematics, Research, Statistical.
- Work Schedule: Flexible.
- Other Requirements:
- Excellent interpersonal, verbal, written, and listening communication skills with a high level of comfort in recommending and implementing solutions.
- Strong analytical, problem solving, organizational, prioritization and time management skills.
- Ability to work efficiently, pay strict attention to detail and deliver high quality results in a deadline driven environment, while effectively managing associated stress.
RESPONSIBLE TO: Director
EMPLOYEE SUPERVISED: None
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