Harris Health System
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Director, Network Administration (CHC)
at Harris Health System
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.
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.
The Director, Network Administration is a key leadership role in the management of the Network Administration Department at Community Health Choice with primary responsibilities for process management and improvement, reporting to regulatory bodies (HHSC, CMS, TDI) and management of delegated entities (pharmacy, behavioral health, vision and dental). Primary liaison with Claims and Contract Configuration Teams to ensure smooth flow of accurate information from Contracting and checks and balances between the processes of each department. Responsible for provider data audits and working with process owners to address deficiencies and subsequently working with the Performance Excellence department to improve related processes. Responsible for claims quality and claims audits including oversight of claims adjudication process of delegated entities. Works collaboratively with the Director of Contracting and Provider Relations to ensure proper training of Community personnel on interfaces between Contracting and other departments. Ongoing management of provider contract management system once implemented.
Benefits and 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.