Humana Clinical Specialist - (FULLY Bilingual, CPT, ICD, Call center exp. ) San Juan in San Juan, Puerto Rico

Role: Clinical Specialist Assignment:Health Risk Assessment
*Location: *El Mundo Office Bldg. - San Juan, Puerto Rico

Humana’s dream is to help our members and our own associates achieve lifelong well-being. Use your clinical experience to work with patients and providers in a nontraditional environment where your knowledge will make a difference. Our associates know their work is vitally important; we strive to ensure we provide perfect service with one-on-one member interactions/as a Clinical Specialist/. Humana’s Perfect Service® means getting the basics done right, delivering value and quality, providing guidance on needs, and being engaged with our members. We want to help our members make the right choices to live life fully. We begin that process by connecting our members with an associate who cares.

Assignment Capsule Be a part of our Clinical Space- Provide guidance to facilitate interaction or services that connect people with lifelong well-being.

As a Clinical Innovations Specialist you will contribute to the success of Humana’s business strategy by collecting broad based information and gathering resources and data in order to arm the team with the tools necessary to enhance consumer engagement, choice, and trust. The Specialist will provide general support directly to clinical activities and clinical staff. * Work with members thru telephone communication to review their health information for Medicare members

  • Complete provider outreach within specified timeframes to obtain standard patient clinical information for all patients identified for review, per program workflow and protocols.

  • Complete required documentation and perform other responsibilities as necessary

    Role Essentials

  • At least two years college education or an Associate Degree

  • Capacity to manage multiple tasks

  • Be available to work during the hours of 8:00am - 6:00pm, Monday – Friday, with occasional weekends and OT based on business need

  • Ability to work in a fast paced environment and to handle a constant volume of phone inquiries.

  • Strong typing and computer skills and experience using multiple computer applications simultaneously.

  • Fully Bilingual English/Spanish. Must be able to speak, read and write in both languages without limitations or assistance. See Additional Information on testing Role Desirables

  • Previous healthcare experience

  • Previous inbound call center experience

  • Knowledge in Medical Terminology (ICD-9, ICD-10, CPT, HCPC's)

  • Proficiency in Microsoft Office applications, including Word, Excel and Power Point

  • Computer system knowledge (e.g. CCMS platform)

    Reporting Relationships

    You will report to a Frontline Leader. This area is under the leadership of a Director & Chief Medical Officer

    Additional Information

    Humana is an organization with careers that change lives—including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you’re ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.

    Language Proficiency Testing Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.

Title: Clinical Specialist - (FULLY Bilingual, CPT, ICD, Call center exp. ) San Juan

Location: Puerto Rico-San Juan

Requisition ID: 179058