Ejecutivo(a) De Cuenta Concierge

Mcs-Healthcare-Holdings,-LLC; San Juan (PR); On-site; USD 60,000 - 90,000; Full time

Job summary

MCS Health seeks a client services professional responsible for receiving referral calls and web inquiries from VIP customers, registering them in the appropriate databases, and developing lasting relationships with customers and their staff by managing clinical project information and addressing insurer concerns.

You will coordinate meetings, deliver corporate presentations, prepare performance reports, and work with internal departments and providers to ensure coordinated service, timely case

Responsibilities

• Receive referral calls and web inquiries from VIP customers and register them in databases.
• Develop lasting relationships with customers and staff by managing clinical project information and insurer interactions.
• Coordinate meetings and prepare and deliver presentations for VIP clients.
• Collaborate with internal departments to plan activities related to VIP service implementation.
• Prepare performance reports and action plans to support the business relationship.
• Gather information and documents to oversee service requests for the served population.
• Identify resources needed to handle service situations and coordinate with providers.
• Analyze utilization data on capitated models and discuss with providers to support strategy.
• Submit work plans and visit schedules to management as requested.

Job description

Responsible for receiving all referral calls and web inquiries from VIP customers, overseeing them courteously and appropriately, and registering them in the appropriate databases. Accountable for developing lasting relationships with customers and their staff by managing clinical project information and identifying and addressing situations with the insurer. Coordinates meetings and makes presentations. Discusses reports and metrics that support the business relationship with the provider.

ESSENTIAL FUNCTIONS:

• Oversees calls from VIP Customers to guarantee that the performance of those employees complies with the work plan and inherent tasks, as well as with the company’s policies, standards, norms, and procedures.
• Visits VIP clients on an ongoing basis to collect relevant documents and/or information to address coordination, approval, case resolution, complaints, grievances, and other issues.
• Performs corporate presentations to existing or potential clients about the services offered in the unit.
• Collaborate with internal departments to plan and coordinate with internal and external units all activities related to the orientation and implementation of the unit’s services for executives and VIP customers, as established.
• Prepares performance reports, establishes action plans in cases of non-compliance, and offers recommendations to upper management to support the business relationship successfully.
• Gathers all information and/or documents necessary to oversee any service request from the population served by the unit.
• Identifies and maintains contact with internal and/or external resources needed to handle and solve service situations and requests. Coordinates with the facility or the provider and guarantees that coordinated service is provided as required.
• Analyzes utilization data on capitated contract models and discusses with assigned specialist providers to achieve prescriptive changes that support the strategy.
• Prepares and submits work plans and visit schedules to management, as requested.

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, preferably in Business Administration. At least three (3) years of experience in project management and report preparation and analysis, preferably within the Health Insurance Industry.

“Proven experience may be replaced by previously established requirements.”

Certifications/Licenses:

Not required.

Other:

Proficiency in Excel, Word, and PowerPoint. Experience with PowerMHS TrueCare, and PharmPix is preferred.

Languages:

Spanish – Advanced (comprehensive, writing and verbal)

English – Advanced (comprehensive, writing and verbal)

“We are an Equal Employment Opportunity Employer and take Affi rmative Action to recruit Protected Veterans and Individuals with Disabilities.”

MCS Healthcare Holdings, LLC. (MCS)is an Equal Employment Opportunity Employer and take Affi rmative Action to recruit Protected Veterans and Individuals with Disabilities. MCS is a participating E-Verify employer.