Hybrid Clinical Services Specialist

TPIS; San Juan (PR); Hybrid; USD 26,000 - 40,000; Full time

Job summary

TPIS in San Juan, PR is seeking a clinical administrative support specialist responsible for receiving, registering, and forwarding requests for organizational determination and related clinical documentation for insured management. This role requires strong attention to detail and healthcare industry background.

This role will perform gatekeeper tasks, validate information with providers, and coordinate with clinical areas to ensure timely processing while maintaining HIPAA compliance in a

Qualifications

• Associate’s Degree and/or 60–64 university credits required.
• Knowledge of Medical Terminology; CPT and ICD-10 Codes preferred.
• Fluency in English and Spanish preferred for written and spoken communication.

Responsibilities

• Receive via fax, email, mail, or provider portal requests for pre-service organizational determination and/or clinical documentation.
• Perform gatekeeper roles to classify and distribute documentation to technicians.
• Check fax expiration dates in coordination with the group leader.
• Analyze documentation to determine service type and urgency, ensuring minimum requirements are met.
• Perform eligibility search and pre-authorization per requirements and validate with providers.

Skills

Medical terminology

Bilingual English/Spanish

Attention to detail

Education

Associate’s Degree or 60–64 university credits

Job description

TPIS in San Juan, PR is seeking a clinical administrative support specialist responsible for receiving, registering, and forwarding requests for organizational determination and related clinical documentation for insured management. This role requires strong attention to detail and healthcare industry background.

This role will perform gatekeeper tasks, validate information with providers, and coordinate with clinical areas to ensure timely processing while maintaining HIPAA compliance in a