Healthcare Admin Representative HCBS - San Juan, PR
About The Position
The Clinical Admin Coordinator in the Home and Community-based Services department supports member intake and administrative coordination with hospitals and the clinical team. The role includes initial member triage, administrative intake, and managing admission or discharge information after notification. It also handles outbound calls, service requests from providers and members, information about available network services, and transfers to clinical staff when appropriate. The position manages referrals and prior authorizations, including intake, notifications, and census activities. It responds to customer service inquiries, reviews fax requests, communicates authorization status to providers and patients, and coordinates with the clinical team to ensure providers receive responses when needed. An English proficiency assessment is required after application.
Requirements
- At least 1 year of experience in a healthcare environment.
- At least 1 year of experience in a production environment.
- At least 1 year of experience analyzing and solving customer problems in an office or customer service environment.
- Experience using Microsoft Word to create, edit, and save documents and Microsoft Excel to create, edit, and save spreadsheets.
- Experience working with a PC and Windows applications.
- Professional English proficiency; an English proficiency assessment is required after application.
- Ability to use complex database systems and production platforms simultaneously.
- Willingness or ability to work 40 hours per week during standard business operating hours, Monday through Friday, 7 a.m. to 8 p.m. AST; occasional overtime on weekends and holidays may be necessary based on business needs.
- Ability to undergo cross-training in accordance with business needs.
Nice To Haves
- Experience with ICD-9/10 and HCPC coding systems.
- Knowledge of Managed Care, Medicaid, Medicare, and Commercial rules and state regulations.
- Solid analytical and problem-solving skills.
- Ability to work independently and as a team player with other departments.
Responsibilities
- Conduct initial member triage and administrative intake, and manage admission or discharge information following notification.
- Manage outbound calls and requests for services from providers and members; provide information about available network services and transfer members to clinical staff as appropriate.
- Manage the referrals process, including incoming and outgoing referrals and prior authorizations.
- Resolve customer service inquiries, including entering authorizations, providing authorization status, and determining whether authorization is required.
- Determine whether authorization is required for requested medical services.
- Communicate with providers and patients about the status of authorization requests.
- Prioritize and organize work to meet agreed-upon deadlines.
- Serve as a primary point of contact for providers or members regarding medical, behavioral, or clinical services or benefits.
- Extract and review fax requests for medical or clinical services.
- Communicate with the clinical team to ensure providers receive responses when necessary.
- Undergo cross-training in accordance with business needs.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
