Client Services Coordinator 2

APS Health Care PR; San Juan (PR); On-site; USD 32,000 - 45,000; Full time

Job summary

APS Health Care PR in Puerto Rico seeks a Client Services Coordinator 2 to deliver outstanding service to members, providers, facilities, and staff. You will assess needs and coordinate responses to ensure smooth operations.

This role is dedicated to the Quality Department, requiring strong organization, regulatory awareness, and proficient MS Office skills. Minimum 2 years in customer service and a high school diploma are expected.

Qualifications

• Minimum 2 years of experience in a customer service position.
• Proficient with Microsoft Word, Excel, PowerPoint and Outlook at an intermediate level.
• High School Diploma required.

Responsibilities

• Complies with CMS and regulatory guidelines where applicable.
• Recognizes customer needs to assist in a complaint, grievances, or appeals.
• Receives, prepares, and manages a complaint, grievances, or appeal file.
• Maintains a record of grievances and appeals using various documentation systems.
• Conducts investigations to resolve complaints, grievances, and appeals.
• Maintains database by entering information and sending letters to beneficiaries and facilities when regulations apply.
• Monitors and complies with notification timelines to beneficiaries and facilities.
• Uses clinical data only for non-interpretive activities related to service requests.
• Other duties assigned by the manager or supervisor.

Skills

Customer service

Education

High School Diploma

Tools

Microsoft Word

Excel

PowerPoint

Outlook

Job description

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:

• Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable.
• Recognizes customer needs to assist in a complaint, grievances, or appeals.
• Receives, prepares, and manages a complaint, grievances, or appeal file.
• Maintains a record of grievances and appeals utilizing various documentation operating systems.
• Conducts investigations to resolve complaints, grievances, and appeals.
• Maintains database by entering information related to the department. Sends letters to beneficiaries and facilities when the regulations are applicable.
• Monitors and complies with the period to send notifications to the beneficiaries and the facility.
• 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.
• In addition, all other duties assigned by the manager and/or supervisor.

Education:

• High School Diploma required.

Experience:

• Minimum 2 years of experience in a customer service position.
• Personal computer experience should include working with Microsoft Word, Excel, Power Point and Outlook at the intermediate level at a minimum.