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About Us
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 Profile
JOB SUMMARY:
Serves as the point of contact for Subcontractors and/or Third Party Administration services provided to key clients and vendors.
Negotiates or assists the Sr. Manager of Vendor & Client Relations with Subcontractors (e.g. dental, vision, pharmaceutical, etc.) and Third Party Administration services (e.g. contracts and claims issues). As needed, collaborates with internal departments to ensure input into Subcontractors and Third Party Administration services contracts prior to execution for optimal administrative efficiency, as well as accurate implementation and on-going reporting. Accountable for maintaining the relationship with Subcontractors and Third Party Administration clients, creating and negotiating contracts, auditing and ensuring contract compliance and resolution of various issues related to services, which may include, but are not limited to, regulatory compliance, member/provider complaints, data reporting, claims payment, invoice generation and payment receipt and provider access & availability.
MINIMUM QUALIFICATIONS:
Education/Specialized Training/Licensure:
Bachelor's degree or 4 years relevant experience in lieu of degree.
Work Experience (Years and Area):
Bachelor's degree and 4 years relevant experience; or 8 years of experience in lieu of degree
Management Experience (Years and Area): none
Software Operated: Microsoft Office (Word, Excel, Outlook)
SPECIAL REQUIREMENTS:
Communication Skills:
Above Average Verbal (Heavy Public Contact)
Above Average Writing /Composing (Correspondence / Reports / Contracts)
Other Skills:
Analytical
Mathematics
Medical Terminology
Research
Statistical
MS Word
MS Excel
Contract Terminology
Advanced Education: Advanced Training Specialty: Business, legal and healthcare
Work Schedule: Hybrid
RESPONSIBLE TO: Supervisor/Manager
EMPLOYEES SUPERVISED: None
Benefits & EEOC
Community employees¿ benefits are provided by Harris Health. These benefits are designed to provide you with flexibility and choices in meeting your specific needs.
Community is an Equal Opportunity Employer.
Harris Health System's benefits program is designed to provide you with more flexibility and choices in meeting your specific needs. Harris Health System's benefits program allows you to protect your income in case of illness, death and disability, and to help you save for retirement.
It is the policy of Harris Health System to provide equal opportunity for all applicants for employment regardless of political affiliation, race, color, national origin, age, sex, religious creed or disability. Applicants may request any reasonable accommodation(s) to participate in the application process.
Job Category
Community Health Choice (CHC)