Health Services Associate - 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 Plan's (PCHP's) Health Services Associate is responsible for supporting the Health Services Department by providing support for case management, clinical appeals, discharge planning, disease management, population health, behavioral health, and utilization review processes. Review documents for accuracy, expedite general workflows, assist in member intakes, communications, and scheduling of follow-ups.

Minimum Specifications

Education

• Bachelor's degree in business administration or related field is required.
• Bachelor's degree in a health-related field is preferred.

Experience

• 3 years of experience in customer engagement or customer service.
• Experience in Insurance, Managed Care, or Health Care is highly preferred.
• If serving members with Behavioral Health needs or supporting Behavioral Health related business processes, experience with Behavioral Health care is preferred.

Equivalent Education and/or Experience

• May have an equivalent combination of education and experience to substitute for the education and/or experience requirements.

Certification/Registration/Licensure

• Community Health Workers (CHW) certification is preferred.
• Medical Assistant certification is preferred.

Skills or Special Abilities

• Clear and professional verbal and written communication skills.
• Practiced with accurate spelling and good grammar.
• Flexible and well organized.
• Able to prioritize and multi-task.
• Able to read and utilize reports and tracking tools.
• Ability to use basic problem-solving skills.
• Proficient with office machines (i.e. copier, fax, telephone), and personal computer.
• Knowledge of relevant software applications including Microsoft Office, email and internet.
• Good numeracy skills.
• Accurate keyboard skills.
• Familiar with medical and managed care terminology is preferred.
• Bi-lingual in English and Spanish is preferred.

Responsibilities

Operations

• Manages correspondence with providers, members, and health plan staff.
• Secures member demographics and medical information by using great discretion and ensuring that all procedures are in compliance with HIPAA, contractual requirements, state and federal regulations, and PCHP policy.
• Receives inbound and outbound calls to members, providers, and all other inquiries.
• Interviews members to determine how they can be assisted in receiving services and procedures.
• Performs administrative task such as creating member records, maintaining case files, updating referral information, verifying information related to benefits ensuring that the information is properly updated.
• Reviews accuracy and completeness of information requested and ensure that all supporting documents are present.
• Works cooperatively with all staff in expediting the general flow of matters pertaining to the case.

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 and compliance

• Ensures work is carried out in compliance with regulatory and/or accreditation standards as well as contractual requirements.
• Follows NCQA standards, health plan utilization management, appeals and service coordination policies.
• Participates in self-audits and peer reviews to ensure compliance with regulations, standards, and departmental policies.

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.

Job Accountabilities

1. Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of PCHP.
2. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
3. Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding.

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.