Enrollment Analyst - PCHP (Hybrid)
Company: Parkland Health and Hospital System (PHHS)
Location: Dallas
Posted on: March 17, 2025
|
|
Job Description:
Interested in a career with both meaning and growth? Whether
your abilities are in direct patient care or one of the many other
areas of healthcare administration and support, everyone at
Parkland works together to fulfill our mission: the health and
well-being of individuals and communities entrusted to our care. By
joining Parkland, you become part of a diverse healthcare legacy
that's served our community for more than 125 years. Put your
skills to work with us, seek opportunities to learn and join a
talented team where patient care is more than a job. It's our
passion.Primary Purpose:Parkland Community Health Plan's (PCHP's)
Enrollment Analyst will enhance the member experience by ensuring
that enrollment processes are maintained and operated
effectively.Minimum SpecificationsEducation- Associate degree.-
Bachelor's degree in a relevant field such as healthcare
administration, business administration, or related discipline
preferred.Experience- Two (2) years of Member Enrollment experience
in a managed care organization.- Experience using payer systems,
preferably Cognizant QNXT.- Experience with Texas Medicaid
preferred.- Experience using business intelligence tools is a
plus.- Spanish language fluency is a plus.Equivalent Education
and/or Experience- May have an equivalent combination of education
and/or experience in lieu of specific education and/or experience
as stated above.Skills or Special Abilities- Excellent verbal and
written communication skills including the ability to communicate
effectively and professionally across disciplines.- Ability to
communicate complex information in understandable terms.- Strong
interpersonal and conflict resolution skills with the ability to
establish and maintain effective working relationships across and
beyond the organization.- Excellent analytical and problem-solving
skills.- Strong time management and organizational skills with the
ability to manage multiple demands and respond to rapidly changing
priorities.- Strong working knowledge of enrollment, eligibility,
and other payer system functions.- Ability to write clearly and
succinctly with a high level of attention to detail.- Proficient
computer and Microsoft Office skills. Ability to learn new software
programs.- Knowledge of Texas Medicaid, National Committee for
Quality Assurance (NCQA), the Uniformed Managed Care Contract, and
the Uniform Managed Care Manual.ResponsibilitiesOperations:Oversees
processing of periodic enrollment files / transactions across all
plans.Reconciles and maintains accurate enrollment records across
PCHP systems.Reconciles revenue and follows up with Finance and
plan sponsors on any payment discrepancies.Serves as a key
point-of-contact for enrollment / eligibility issues and works with
delegated vendors to address processing questions.Review and track
processing exceptions, working with plan sponsors and EDI
processing teams as required.Serves as liaison between PCHP
departments and TX Medicaid Enrollment Broker.Serves as SME working
on IT projects and with delegated vendor organizations.Monitors
downstream processing such as distribution of Member ID cards and
welcome packets to ensure timeliness and completeness of
processing.Ensures effective communication around potential
business impacts and escalates and informs stakeholders,
departments, and vendors as appropriate.Quality:Integrate health
literacy principles into all communication including Members and
Providers.Support strategies that meet clinical, quality and
network improvement goals.Promote the use of Health Information
Technology to support and monitor the effectiveness of health and
social interventions and make data-driven recommendations as
needed.For staff in clinical roles, foster collaborative
relationships with members and/or providers to promote and support
evidence-based practices and care coordination.RegulatoryEnsures
work is carried out in compliance with regulatory and/or
accreditation standards as well as contractual
requirements.Maintain business processes in accordance with Texas
Medicaid Member Enrollment Regulations and Processing
Guidelines.Professional AccountabilityPromotes and supports a
culturally welcoming and inclusive work environment.Acts with the
highest integrity and ethical standards while adhering to
Parkland's Mission, Vision, and Values. Adheres to organizational
policies, procedures, and guidelines.Completes assigned training,
self-appraisal, and annual health requirements timely.Adheres to
hybrid work schedule requirements. Attends required meetings and
town halls.Recognizes and communicates ethical and legal concerns
through the established channels of communication.Demonstrates
accountability and responsibility by independently completing work,
including projects and assignments on time, and providing timely
responses to requests for information.Maintains confidentiality at
all times.Performs other work as requested that is reasonably
related to the employee's position, qualifications, and
competencies.Parkland Health and Hospital System prohibits
discrimination based on age (40 or over), race, color, religion,
sex (including pregnancy), sexual orientation, gender identity,
gender expression, genetic information, disability, national
origin, marital status, political belief, or veteran status.As part
of our commitment to our patients and employees' wellness, Parkland
Health is a tobacco and smoke-free campus.Required
Keywords: Parkland Health and Hospital System (PHHS), Dallas , Enrollment Analyst - PCHP (Hybrid), Professions , Dallas, Texas
Click
here to apply!
|