Coordinador(a) del Programa de Planes de Necesidades Especiales
Regular
Non-Exempt
GENERAL DESCRIPTION:
Responsible for the receipt and distribution of the list of members and/or potential members who require evaluation for the qualification of Special Supplementary Benefits. Answers and refers the complaints and grievances received through the corresponding unit. Confirms the chronic conditions for the C-SNP plan members. Act as a liaison between different departments or stakeholders, ensuring a smooth and effective process communication.
ESSENTIAL FUNCTIONS:
Works on the list of members (potential or current) who require evaluation for the qualification of Special Supplementary Benefits and derives the cases to take the corresponding actions.
Maintains an updated log of the status of cases received, pending, and completed in the unit.
Reconciles the list of cases received and compares it with the cases derived to ensure that they are being examined in compliance with the established timeframe.
Monitors and follows up with physicians regarding pending cases.
Receives cases from the Grievances and Appeals unit and refers them to the necessary areas to ensure they are completed per the corresponding process.
Contacts physicians to obtain confirmation that the member has a qualifying condition for the Chronic Condition Special Needs Plan (C-SNP) on a post-enrollment basis.
Contact members by phone to obtain current providers information, if necessary.
Receives and appropriately direct incoming calls form the members and physicians.
Completes C-SNP confirmation process (attempts, documentation, and assessment) in the electronic file in TruCare according to the policies and procedures.
Performs data entry in TruCare of self-assessments completed by members or authorized representative.
Assists and maintains assigned reports to comply with established productivity metrics, quality, and timeliness as required per applicable regulations.
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:
60 university credits equivalent to two (2) years of studies or an associate degree. At least one (1) year of related experience.
"Proven experience may be replaced by previously established requirements."
Certifications / Licenses:
N/A
Other:
N/A
Languages:
Spanish –
Intermediate (writing, conversational, and comprehension)
English –
Intermediate (writing, conversational, and comprehension)
"Somos un patrono con igualdad de oportunidad en el empleo y tomamos Acción Afirmativa para reclutar a Mujeres, Minorías, Veteranos Protegidos y Personas con Impedimento
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