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.
JOB SUMMARY: The Enrollment Data Specialist performs operational solutions to optimize membership enrollment and premium billing accuracy and collaborates and supports internal and external customers. This position researches and reconciles systemic eligibility/enrollment or premium billing /payment discrepancies to arrive at a consistently compliant disposition and operates in a fast-paced environment with frequent priority changes. The Enrollment Data Specialist is held responsible for understanding and abiding by State, Federal, and organizational guidelines for various lines of business related to Membership enrollment and reconciliation.
MINIMUM QUALIFICATIONS:
Education/Specialized Training/Licensure: High school diploma
Work Experience (Years and Area): Two (2) years related experience with health insurance, managed care, or customer service; Knowledge of eligibility files /premium billing, Medicaid, Marketplace, Medicare preferred
Management Experience (Years and Area): N/A
Software Operated: Microsoft Office ( Word, Excel, and Outlook), SQL a plus
SPECIAL REQUIREMENTS: (Check Applicable Areas)
Exceptional Verbal (e.g., Public Speaking)
Writing /Composing: Correspondence / Reports
Other Skills: Mathematics, Medical Terminology, Research, Statistical
Advanced Education:
Work Schedule: Flexible, Overtime
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, mathematic, organizational, prioritization and time management skills.
Ability to work efficiently, pay strong attention to detail and deliver high quality results in a deadline driven environment, while effectively managing associated stress.
RESPONSIBLE TO: Supervisor/Manager
EMPLOYEE SUPERVISED: N/A
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