November 5, 2024

APS Health Care PR

San Juan

FULL TIME

Client Services Coordinator 2

Position Summary:
The Client Services Coordinator 2 / G&A provides outstanding customer service. This key individual communicates with a wide variety of external contacts including members, providers, facilities, as well as clinical and operational staff. The Client Services Coordinator assesses the needs of internal and external clients in a timely and efficient manner, thus resulting in optimum operational performance. The Client Services Coordinator 2 is fully dedicated to duties of the Quality Department. This employee is not responsible for conducting any UM review activities that require interpretation of clinical information.
Essential Functions:
1. Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable..
2. Recognizes customer needs to assist in a complaint, grievances, or appeals..
3. Receives, prepares, and manages a complaint, grievances, or appeal file.
4. Maintains a record of grievances and appeals utilizing various documentation operating systems.
5. Conducts investigations to resolve complaints, grievances, and appeals.
6. Maintains database by entering information related to the department.
7. Sends letters to beneficiaries and facilities when the regulations are applicable.
8. Monitors and complies with the period to send notifications to the beneficiaries and the facility.
9. Use of clinical data is limited to: Performance of review of service request for completeness of information; Collection and transfer of non-clinical data; and Acquisition of structured clinical data; and Activities that do not require evaluation or interpretation of clinical information.
10. In addition, all other duties assigned by the manager and/or supervisor.

Education:

Bachelor’s degree required

Experience:

Minimum 2 years of experience in a customer service position.

Knowledge:

Knowledge in medical terminology preferred.
Personal computer experience should include working with Microsoft Word, Excel, Power Point and Outlook at the intermediate level at a minimum.