Harris Health System

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Job Details

Provider Communication Representative I

at Harris Health System

Posted: 2/6/2020
Job Status: Full Time
Job Reference #: 149654
Categories: Sales, Customer Service
Keywords: support

Job Description

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.

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

The Provider Communications Representative I is a position within the Community Health Choice Provider Call Center. The Provider Communications Representative I is primarily responsible for, but not limited to responding to incoming provider hotline inquiries as they relate to benefits and eligibility verification, claim status (with the ability to identify if a claim requires reconsideration), authorization status, and complaints, accurate documentation recording of all provider calls; effective follow-up of provider calls, as required; and proper electronic routing with effective documentation skills.


  • High School diploma or GED.
  • Two years Managed Care experience to include Call Center, with claims knowledge. Cross-functionality in Claims, Benefits and Eligibility for at least two lines of business.


  • Above Average Verbal (Heavy Public Contact)
  • Writing /Composing/ Correspondence /Reports
  • Analytical
  • Mathematics
  • Medical Terms
  • MS Word MS Excel
  • Ability to work independently under minimal direction. Moderate to advanced computer knowledge required.

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.

Job Category

CHC Call Center Operations

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!