Patient Services Coordinator

JOB PURPOSE:

• The Patient Service Coordinator is primarily responsible for providing personalized concierge support to members throughout their healthcare journey. This role facilitates access to appropriate health services, supports medical navigation and directional care based on quality standards, and coordinates appointments, referrals, interconsultations, and second medical opinions. The position requires consistent communication and follow-up with members, families, agents, providers, and internal teams to ensure timely support, continuity of care, and high-quality member experience.

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES:

• Provide concierge support to members when medical services, guidance, or navigation assistance are required.
• Verify policy eligibility and coordinate with the appropriate internal teams to support timely access to covered services according to established guidelines.
• Work closely with Precertification and Case Management to support appointment scheduling, medical consultations, second opinions, interconsultations, referrals, and provider access needs.
• Monitor and respond to emails and service requests professionally within established turnaround times.
• Maintain direct communication with members, agents, providers, and families via approved channels, including phone, email, and WhatsApp, when applicable.
• Support members receiving care in the United States or internationally, including follow-up during hospitalization and after discharge when required.
• Provide steering to preferred providers and Centers of Excellence based on service standards, network access, quality considerations, and internal guidance.
• Request and follow up on medical records, clinical updates, appointment confirmations, and provider documentation as needed.
• Escalate high-cost or complex cases to Case Management and Precertification when additional clinical, financial, or operational review is needed.
• Provide assistance with internal tools and workflows used for patient navigation, case tracking, and service coordination.
• Support quality of care reviews, provider service concerns, and clinical quality investigations by gathering information and escalating to leadership as appropriate.
• Educate members and agents on available Patient Services resources, required documentation, timelines, and next steps.
• Maintain accurate case documentation, follow-up notes, and communication history in accordance with departmental standards.
• Maintain service levels and turnaround times established by the Patient Services department.
• Follow company guidelines regarding confidentiality, attendance, dress code, professionalism, and compliance.

• Knowledge of ICD/CPT codes

DESIRED MINIMUM QUALIFICATIONS:

• Medical or clinical background preferred, ideally as a nurse, physician, medical assistant, or healthcare professional with experience in patient care coordination, medical services, hospital operations, health insurance, or patient navigation.
• Service-oriented, prompt, courteous, and committed to providing high-quality member experience.
• Positive, customer-focused attitude demonstrated adaptability to operational changes.
• Strong judgment and discretion, especially when handling sensitive member information and complex cases that may have financial or operational impact.
• Ability to work independently and collaboratively as part of a team.
• Ability to manage stressful situations with professionalism, empathy, and emotional intelligence.
• Clear verbal and written communication skills in English, Spanish and Portuguese.
• Strong attention to detail, self-motivation, follow-up discipline, and organizational skills.
• Ability to manage a balanced workload, prioritize competing requests, and multitask in a high-volume environment.
• Proficiency with MS Office, email, Excel, Word, and standard office equipment.
• Ability to handle a high volume of calls, emails, and time-sensitive service requests.
• Knowledge of medical terminology, ICD/CPT codes, and the U.S. healthcare system is a plus.
• Prior experience with international health insurance, concierge medicine, case coordination, or patient navigation is preferred.

EDUCATION AND EXPERIENCE:

• College education required.
• Medical or clinical education/background is preferred, including nursing, medicine, medical assistance, or other healthcare-related training.
• A minimum of one (1) year of experience in a healthcare, medical administrative, insurance, patient services, or customer service environment.
• Experience working in the U.S. healthcare system is a plus, including experience in an insurance company, hospital, physician’s office, or similar healthcare setting.
• Prior experience in international health insurance
• Opportunity for on-the-job training may be available based on previous experience.