Managed Care Coordinator II, Bilingual – Spanish

Jobtailor; Deutschland; Remote; EUR 38.000 - 52.000; Vollzeit

Zusammenfassung

Jobtailor is seeking a bilingual Healthcare Operations Coordinator to support clinical operations, liaise with members, providers, and coordinators, and ensure accurate data collection and case routing. The role involves translating clinical documents between English and Spanish and overseeing escalated issues under supervision.

The ideal candidate has 3–5 years of customer service, medical terminology knowledge, and the ability to work with CMS and NCQA requirements in a healthcare delivery

Qualifikationen

• High School Diploma or GED required.
• 3–5 years of customer service experience.
• Medical Certification Translator Education required (Letters Team).
• Knowledge of medical terminology.
• Good oral and written communication skills.
• Ability to make sound decisions under supervisor guidance.
• Knowledge of NCQA accreditation standards and CMS/state laws.

Aufgaben

• Support Clinical Operations and liaise between members, physicians, delegates, and coordinators.
• Provide leadership to non-clinical team and handle escalated issues.
• Review service requests, collect data, and acquire structured clinical data.
• Prepare and route cases for clinical review.
• Translate documents between English and Spanish using medical terminology.
• Assist onboarding and training of Managed Care Coordinators.
• Authorize services under clinical supervisory oversight.
• Review medical, dental, and vision claims and address gaps in preventive care.

Kenntnisse

Bilingual English/Spanish

Customer service

Interpersonal Skills

Analytical Skills

Decision-Making

Ausbildung

High School Diploma/GED

Medical Certification Translator Education

Tools

Claims Processing Software

Document Translation Tools

Healthcare IT Systems

Jobbeschreibung

• Support Clinical Operations and act as a liaison between members, physicians, delegates, operational business members and member service coordinators.
• Provide leadership and guidance to the non-clinical team and handle escalated issues/problems.
• Review service requests for completeness, collect and transfer non-clinical data, and acquire structured clinical data from physicians/patients.
• Prepare, document and route cases for clinical review.
• Initiate callbacks and correspondence to members and providers to coordinate and verify benefits and courses of treatment.
• Collect and collate information required to handle escalated phone and correspondence inquiries.
• Investigate and resolve inquiries, then coordinate and verify case completion with physicians/members.
• Assist with onboarding and training newly hired Managed Care Coordinators I and other Managed Care Coordinators.
• Act as liaison with providers, members and Care Managers.
• Authorize services based on scripts or algorithms for pre-review screening under clinical/supervisory oversight.
• Perform initial screening of precertification requests using established scripts and workflows.
• Assist members with finding providers, resolving problems, answering questions, filing appeals and obtaining services.
• Engage members in Case Management and complete health assessments.
• Distribute new case assignments to Case Management Clinical Staff.
• Review medical, dental and vision claims and address gaps in preventive care.
• Educate members about preventive health activities and services.
• Assist members with appointments, transportation, PCP and demographic changes, and new ID cards.
• Triage and distribute referrals and provider faxes.
• Review medical and administrative documentation for accuracy, grammar and regulatory compliance.
• Screen determination letters before distribution.
• Translate clinical and non-clinical documents between English and Spanish using precise medical terminology.
• Make timely decisions under supervisor direction.

Requirements

• High School Diploma/GED required.
• 3-5 years customer service experience.
• Medical certification translator education (Letter’s Team, Medically Certified Spanish Translator only).
• Requires knowledge of medical terminology.
• Requires good oral and written communication skills.
• Requires ability to make sound decisions under the direction of Supervisor.
• Requires knowledge of clinical standards of care and Star measures.
• Requires operational knowledge of health care delivery systems and health insurance industry.
• Requires appreciation for strategic planning.
• Requires knowledge of NCQA accreditation standards and state and federal laws applicable to health plan appeals and grievances (Letters Team, Medically Certified Spanish Translator).
• Requires knowledge of CMS and state regulatory requirements (Letters Team, Medically Certified Spanish Translator only).
• Team Player, Strong Analytical, Interpersonal Skills.
• Required to work one holiday shift per year.
• May require some travel.
• Review and translate documents in both English and Spanish.
• Prefer knowledge of contracts, enrollment, billing & claims coding/processing.
• Prefer knowledge of Managed Care principles.
• Prefer ability to analyze and resolve problems with minimal supervision.
• Prefer ability to use a personal computer and applicable software and systems.

Core Competencies

Demonstrates expertise in clinical operations support, effective communication in both English and Spanish, and a strong understanding of medical terminology and healthcare delivery systems. Capable of leading non-clinical teams, resolving escalated issues, and ensuring compliance with regulatory standards.

Highest-signal resume keywords

• Medical Terminology Knowledge
• Clinical Standards of Care
• NCQA Accreditation Standards
• Customer Service Experience
• Bilingual Communication (English/Spanish)

Hard Skills

• Clinical Data Collection
• Precertification Request Screening
• Case Management
• Claims Review
• Regulatory Compliance

Soft Skills

• Interpersonal Skills
• Analytical Skills
• Decision-Making
• Team Collaboration
• Problem-Solving

Certifications & Qualifications

• Medical Certification Translator Education

Industry Keywords

• Managed Care Principles
• Health Insurance Industry
• CMS Regulatory Requirements
• State and Federal Laws
• Star Measures

Tools & Technologies

• Health Care Delivery Systems
• Claims Processing Software
• Document Translation Tools