Enrollment Analyst - PCHP (Hybrid)

Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day.

Primary Purpose:Parkland Community Health Plans (PCHPs) Enrollment Analyst will enhance the member experience by ensuring that enrollment processes are maintained and operated effectively.

Minimum Specifications

Education

- 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.

Responsibilities

Operations:

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.

Regulatory

Ensures 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 Accountability

Promotes 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 Community Health Plan (PCHP) 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.