Job Description
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:
Responsible for collection, aggregation, analysis, and presentation of decision support tools for Community Health Choice's contracting department. Supports proposal and counter-proposal development, tracks financial performance of existing contracts and programs and ensures alignment with health plan budgets and forecasts. Contributes to innovative payment models that fundamentally improve the way that healthcare is delivered and reimbursed. Heavy emphasis on hospital contract modeling.
MINIMUM QUALIFICATIONS:
Education/Specialized Training/Licensure: Bachelor's degree preferred in Healthcare Management, Statistics, Economics, Mathematics, Information Systems, or similar.
Work Experience: Four (4) + years of experience in business performance reporting, data analysis, and hospital contract modeling.
Management Experience : Two (2) to Four (4) years management or team leadership experience.
Software Operated: Microsoft Office (Word, Excel, Outlook)
Other Requirements:
Experience in a complex healthcare delivery environment, specifically with government-sponsored programs.
Familiarity with a variety of healthcare data, including claims, provider, utilization, and call center data.
Intermediate to excellent Excel and SQL knowledge.
Familiarity with Power BI tools.
Knowledge of QNXT and NetworX.
Deep understanding of payer-provider contracts that govern reimbursement and the healthcare revenue cycle.
Experience working in a fast-paced environment.
A personal, systematic approach to problem characterization and solution development.
Experience with value-based contracting models, including shared savings and risk-based arrangements.
SPECIAL REQUIREMENTS:
1. Communication Skills:
Writing /Composing (Correspondence/ Reports)
2. Other Skills:
Analytical
Statistical
MS Word
MS Excel
3. Advanced Education:
Bachelor's Degree Major: in Healthcare Management, Statistics, Economics, Mathematics, Information Systems, or similar preferred.
Master's Degree Major: in Healthcare Management, Statistics, Economics, Mathematics, Information Systems, or similar preferred.
Doctorate Major:
4. Work Schedule: Flexible
5. Other Requirements:
Identify, analyze, interpret and validate healthcare data metrics, trends, patterns, issues and/or opportunities for improvement in support of multiple strategic goals.
Evaluation and modeling of provider contracts and networks, specifically hospitals and complex health systems.
Define business questions and transform data and analysis into meaningful and actionable information for contracting and network development.
Interpret, communicate, and present results to multiple levels of management in consistent and easy to understand formats.
Statistical analysis, reporting, and ad-hoc querying of financial, provider network, utilization, and other data from various software databases.
Rely on experience and judgment to plan and accomplish goals.
Ability to meet deadlines and manage multiple projects simultaneously.
Knowledge and understanding of CMS and Texas Medicaid payment methodologies.
Reporting for strategic analysis, profitability, financial analysis, utilization patterns, and network adequacy.
Expertise with healthcare claims data (facility, professional, ancillary.)
Interface and maintain positive interactions with health plan personnel.
