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:
This position is responsible for managing and configuring specified applications/systems such as QNXT and NetworX within Community Health Choice (CHC). The person in this role is expected to maintain performance within the designated applications, manage and develop staff, continuously improve the quality of processes, and work with Leadership to implement new ideas defined for Health Plan needs.
Lead the configuration/solutions development team in the design, development, deployment and sustainment of business process solutions, software systems/applications. Support all departments and constant monitoring of state regulations to comply with the changes.
40% Manages and leads the support and development of system/applications as assigned. Develops standard operating procedures and guidelines for the IS Application Support/Configuration Team. Ensures the appropriate configuration updates and modifications for applications are made within the agreed upon time frame/departmental standards. Commits to proper documentation, testing is conducted for all system/application changes. Proper reporting and audit protocols are documented and managed to ensure internal controls are met. Reviews ticket/request queues daily to ensure that all state and federal claims processing regulations are being met by Community Health Choice. Establishes and implements short and long-term goals, objectives, policies, and operating procedures for the business applications that link to contractual and statutory regulations; sets appropriate stretch goals and stays focused to persistently drive to meet or exceed
those goals. Promotes process efficiency by working with team to reduce unnecessary steps and delays or develop more effective processes.
20% Acts as a contact for external areas by seeking to understand their business needs, providing information, responding to inquiries, investigating, and resolving problems related to the issues and educating on Health Plan business rules. Ensures ongoing communication and support to meet agreed upon resolutions. Identifies opportunities and makes recommendations to external users for improvements and enhancements; works with other department personnel through the tickets/requests process to determine impacts and feasibility of implementation
of modifications and enhancements.
15% Monitors reported issues and ensures they are assigned to the appropriate area for a resolution within agreed upon timeframes. Reviews frequent issues and works with Leadership to determine and resolve root cause, prevents future occurrences, and reduce degree of business impact. Coordinates efforts of technical and functional team involved in resolutions of reported issues. Enforces policies and procedures to all team members performing issue resolutions. (i.e., escalation of technical and functional issues, resources, and change control). Communicates issue and problem resolution to Leadership. Provides direction to individuals supervised.
15% Provides support to Project Management Office for major implementation projects. Assists in organizing project teams related to assigned systems/applications to ensure appropriate staff for the projects. Ensures necessary tools and resources are available for completion of project (i.e., vendor, equipment, training). Assists in monitoring implementation project to ensure timely completion during course of project. Assists in analysis of problems encountered in projects. Reviews progress or projects on a periodic basis.
10% Actively contributes to achievement of departmental goals, as identified in Department's annual business plan, including specific departmental process improvement plans and other duties as assigned.
MINIMUM QUALIFICATIONS:
Education/Specialized Training/Licensure: Bachelor's degree in computer science, Business or related area.
Four (4) years of related work experience may be substituted in lieu of degree.
Work Experience (Years and Area): 3 years in configuration or application support experience.
Healthcare experience preferred. Experience in the payor side of the business is highly preferred.
QNXT experience is required. Texas Medicaid knowledge is highly preferred.
Management Experience (Years and Area): 1 year of Informal leadership, team lead or project lead experience.
Equipment Operated: PC literacy
SPECIAL REQUIREMENTS:
Communication Skills:
Above Average Verbal (Heavy Public Contact)
Writing /Composing, Correspondence / Reports
Other Skills:
Analytical
Experience with QNXT
CRT
Design
Medical Terms
P.C. MS Word MS Excel
Work Schedule: Hybrid
Other Requirements:
RESPONSIBLE TO: Director