Customer Service Liaison

hace 1 mes


San Juan, San Juan, Puerto Rico Target Human Resources Solutions A tiempo completo

 

Position Summary:

The Client Services Coordinator plays a crucial role at Target Human Resources Solutions, providing exceptional customer service to a diverse range of external contacts, including members, providers, facilities, and internal staff. This key individual assesses client needs in a timely and efficient manner, ensuring optimum operational performance.

 

Essential Functions:

1. Regulatory Compliance:

Comply with guidelines established by the Centers for Medicare and Medicaid (CMS) and other regulatory agencies, as applicable.

2. Customer Support:

Recognize customer needs and provide assistance in complaint, grievance, or appeal situations.

3. File Management:

Receive, prepare, and manage complaint, grievance, or appeal files, maintaining accurate records.

4. Data Management:

Maintain a record of grievances and appeals using various documentation systems.

5. Investigation and Resolution:

Conduct investigations to resolve complaints, grievances, and appeals in a fair and timely manner.

6. Database Maintenance:

Enter information related to the department into the database, ensuring accuracy and completeness.

7. Notification and Compliance:

Send notifications to beneficiaries and facilities when regulations apply, ensuring timely compliance.

8. Limited Clinical Data Use:

Use clinical data only for review of service requests for completeness, collection and transfer of non-clinical data, and acquisition of structured clinical data, without evaluation or interpretation.

9. Additional Responsibilities:

Perform all other duties assigned by the manager and/or supervisor.

 

Requirements:

Education:

Bachelor's degree required.

Experience:

Minimum 2 years of experience in a customer service position.

Knowledge:

Knowledge in medical terminology preferred.

Proficiency in Microsoft Office Suite, including Word, Excel, PowerPoint, and Outlook, at the intermediate level or higher.

 

EEO Statement: Somos un patrón con Igualdad de Oportunidades en el Empleo y tomamos acción afirmativa para reclutar a Mujeres, Minorías, Veteranos Protegidos y Personas con Impedimentos.


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