Home Services Specialist

Regular Exempt GENERAL DESCRIPTION: Serves as a liaison between the company and extended care home administration to coordinate, refer, and manage documents and/or services related to the company’s Home Health Program. Responsible for handling, channeling, and resolving service situations related to complaints, claims, and operational situations of the home care initiatives. Works and channels all services related to the program for all lines of business, in addition to promoting and maintaining a healthy business relationship. Validates and determines the steps to be taken to refer service requests to the appropriate areas, maintains a record of those steps, and follows up to ensure prospect satisfaction, retention, and new referrals. ESSENTIAL FUNCTIONS: Serves as the primary contact for Extended Care Home Administrators and Owners, maintaining a healthy business relationship to attend, channel, and resolve service situations, keeping the quality standards of service and guaranteeing that they are resolved within the established time in compliance with applicable regulations. Responsible for managing and following up on the delivery, mailing, and/or pick up of documents, forms, applications, materials, and/or information related to the Extended Care Homes Program from the beneficiary value programs, within the required frequency and in compliance with the program. Works and maintains visitation schedules to assigned extended care homes to identify needs and keep administrators informed of the various programs that the company has available. Manages and audits (Medplus Solutions) in the delivery of the Home Bundle Benefit to the Long-Term Care Homes. Channels and resolves service barriers related to the Long-Term Care Home Program and enrollees' coverage benefits. Analyzes and identifies root causes of service barriers and/or repetitive complaints submitted by the home administrator; documents analysis and escalates to management with the corrective action process. Participates in the coordination of service quality monitoring programs, initiatives, and educational activities conducive to strengthening relationships with home administrators and keeping them informed of any changes. Performs data entry, document review, form review, and/or Program-related information, as needed, for all lines of business. Provides support by presenting requested information during organizational audits, within the required frequency, and in compliance with the timeframe. Works on planning the logistics and details of strategies and activities within and outside of the company, targeting long-term care homes, according to the established work plan and as required. Maintains constant and effective communication with other company departments for intervention and/or requests for information required to support service to long-term care homes when requested. Maintains log, documentation, and folders for each Home, request, and/or special event to be used for reference: Photocopies, sends, receives, and files documents, as specified by the Unit. Provides status of cases and/or services provided, according to updated information in the documentation system (CRM/RST, PMHS) for Provider Operations (Classicare) and internal clients. Validates and ensures provider information in the different screens of Power Management Health System (PMHS) is correct, as required. Participates on special initiatives to support policyholder premium optimization in long-term care homes, such as Comprehensive Health Risk Assessment (CHRA), Model of Care (MOC), Care Management, and Stars Program. 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:
Bachelor's degree in Business Administration, Health Services Administration, or other health-related fields. At least two (2) years of experience performing functions of initiative management, program management, and provider services management, preferably in the Health Insurance industry. “Proven experience may be replaced by previously established requirements.” Certifications / Licenses: A Driver's License valid in the Commonwealth of Puerto Rico is required. Other: Availability to work extended hours, weekends, and holidays, according to business needs and the requirements of regulatory agencies applicable to the Industry. Must be available to travel around the island conducting home care facility visits. Languages: Spanish – Intermediate (comprehensive, writing and verbal) English – Intermediate (comprehensive, writing and verbal) “We are an Equal Employment Opportunity Employer and take Affirmative Action to recruit Protected Veterans and Individuals with Disabilities.”