Clinical Coordinator

MCS Puerto Rico; San Juan (PR); On-site; USD 30,000 - 45,000; Full time

Job summary

MCS Puerto Rico is seeking an administrative coordinator to manage office duties, coordinate services, and ensure HIPAA-compliant handling of member information. The role serves as a liaison between members, healthcare providers, and the multidisciplinary team to support timely service delivery.

Responsibilities include drafting communications, coordinating meetings, managing equipment requests, and maintaining accurate records. A healthcare background and strong organization are essential.

Qualifications

• Bachelor’s degree in Business Administration or related field; healthcare admin experience preferred.
• Associate degree with 60–64 credits and 1 year healthcare admin experience preferred.
• High school diploma with 2 years healthcare admin experience preferred.

Responsibilities

• Provides comprehensive administrative support for unit operations, including drafting communications, coordinating meetings, and managing equipment/material requests.
• Prepares presentations, reports, graphs, and essential documentation; follows up with other departments for pending information.
• Handles phone communications with members and health service providers, routing calls to clinical teams as needed.
• Proactively contacts members to collect current provider information to ensure data accuracy.
• Assesses service requests for compliance and facilitates timely service authorizations.
• Submits requests through operational platforms to appropriate departments following established protocols.
• Verifies and follows up on pending services with relevant areas to meet timelines.
• Communicates final determinations to members and providers within required timeframes.
• Maintains HIPAA-compliant document filing systems protecting sensitive information.
• Maintains accurate reports to meet productivity, quality, and regulatory standards.
• Coordinates with hospitals or IPAs to monitor and facilitate service delivery to members.
• Escalates issues to supervisor for guidance and serves as a contact point for healthcare facility representatives.

Skills

Administrative support

Communication

HIPAA compliance

Documentation management

Education

Bachelor’s degree in Business Administration

Associate’s degree in Business Administration

High school diploma or equivalent

Job description

General Description

Responsible for managing administrative tasks, coordinating services, and maintaining compliance with established protocols. Serves as a vital link between members, healthcare providers, and the multidisciplinary team within the organization. Facilitates the delivery of services to members in an integrated and timely manner, ensuring streamlined communication and operational efficiency among various departments and stakeholders.

Regular

Non-Exempt

Essential Functions

• Provides comprehensive administrative support related to unit operations, including drafting and sending communication (letters, reports, and presentations), coordinating meetings, and managing requests for equipment and materials.
• Collaborates with team members to prepare presentations, reports, graphs, and other essential documentation while ensuring timely follow-up on pending information with other departments, such as eligibility, benefits verification, and payment agreements.
• Facilitates effective communication by receiving and making phone calls to members and health service providers. Accurately transfer calls to the clinical team and other relevant departments, as necessary.
• Contacts members proactively to gather current provider information, ensuring that all data is up to date and accurate.
• Assess incoming service requests for compliance with criteria and departmental guidelines, facilitating the timely authorization of services as needed.
• Completes and submits requests through operational platforms to the appropriate departments, ensuring adherence to established protocols.
• Verifies, channels, and maintains follow-up on pending services and cases with the relevant areas.
• Communicates final determinations to members and providers within established timeframes, adhering to the department's policies and procedures.
• Organizes and maintains document filing systems in compliance with HIPAA requirements, ensuring confidentiality and security of sensitive information.
• Maintains accurate and detailed reports to meet established productivity metrics, quality standards, and regulatory requirements.
• Coordinates with hospital representatives or medical groups (IPAs) to monitor and facilitate the delivery of services to members.
• Identifies and refers any issues or situations encountered during daily responsibilities to the supervisor or manager for further evaluation and guidance. Serves as a point of contact for representatives from healthcare facilities, ensuring effective communication and resolution of issues.

Additional Functions

• Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
• May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.

Minimum Qualifications

Education and Experience

Bachelor’s degree in Business Administration or related areas. At least six (6) months of previous experience in healthcare settings, particularly in clinical or administrative roles, is preferred.

OR

Education and Experience: An associate’s degree in Business Administration, or related areas, and/or at least sixty to sixty-four (60-64) approved university credits equivalent to two (2) years of studies. At least one (1) year of previous experience in healthcare settings, particularly in clinical or administrative roles, is preferred.

OR

Education and Experience: High School Diploma or Technical Course. At least two (2) years of previous experience in healthcare settings, particularly in clinical or administrative roles, is preferred.

Proven experience may be replaced by previously established requirements.

Certifications / Licenses

N/A

Other

N/A

Languages

• Spanish – Basic (comprehensive, writing, and verbal)
• English – Basic (comprehensive, writing, and verbal)

We are an Equal Employment Opportunity Employer and take Affi...