Client Services Coordinator 2

Position Summary:

The Client Services Coordinator 2 / G&A provides outstanding customer service. This key individual communicates with a wide variety of external contacts including members, providers, facilities, as well as clinical and operational staff. The Client Services Coordinator assesses the needs of internal and external clients in a timely and efficient manner, thus resulting in optimum operational performance. The Client Services Coordinator 2 is fully dedicated to duties of the Quality Department. This employee is not responsible for conducting any UM review activities that require interpretation of clinical information.

Essential Functions:

• Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable.
• Recognizes customer needs to assist in a complaint, grievances, or appeals.
• Receives, prepares, and manages a complaint, grievances, or appeal file.
• Maintains a record of grievances and appeals utilizing various documentation operating systems.
• Conducts investigations to resolve complaints, grievances, and appeals.
• Maintains database by entering information related to the department. Sends letters to beneficiaries and facilities when the regulations are applicable.
• Monitors and complies with the period to send notifications to the beneficiaries and the facility.
• Use of clinical data is limited to: Performance of review of service request for completeness of information; Collection and transfer of non-clinical data; and Acquisition of structured clinical data; and Activities that do not require evaluation or interpretation of clinical information.
• In addition, all other duties assigned by the manager and/or supervisor.

Education:

• High School Diploma required.
• Bachelor's degree preferred

Experience:

• Minimum 2 years of experience in a customer service position.

Knowledge: ·

• Personal computer experience should include working with Microsoft Word, Excel, Power Point and Outlook at the intermediate level at a minimum.