Job Description

To facilitate access to medical care by coordinating Non-Emergency Medical (NEMT) Transportation, Non-Medical Transportation (NMT) transportation and travel-related benefits for members. Coordinates care in collaboration with internal and external partners to help members overcome barriers to care created by lack of transportation.

Responsibilities

• Effectively communicate written and verbally with both members and providers.
• Works directly with members, transportation providers and medical or social service facilities to coordinate appropriate level and timeliness of transports and travel-related services such as meals, lodging and flights within the DHCS guidelines and Partnership policies.
• Support and assist members in the resolution of problems with their transportation or travel benefits. Investigates issues using critical thinking and resolves or escalates as necessary.
• Uses customer service skills to manage member and provider complaints and file grievances or escalate as necessary.
• Communicate immediate health issues to a clinical member of the Care Coordination team and assist as needed in problem resolution.
• Communicate non-transportation related needs to the appropriate team for assistance.
• Establish and maintain effective interpersonal relationships with all levels of health plan staff, other programs, agencies and the general public.
• Verifies member’s eligibility and determines level of program benefit.
• Verifies transportation drop-off/pick-up locations to ensure adherence with Medi-Cal guidelines and uses critical thinking skills to identify potential fraud, waste and abuse.
• Elicit medical information from provider, consulting with HS/UM Clinical Staff as appropriate.
• Contacts provider, verbally and/or in writing to pursue needed information necessary to determine appropriate level of care or authorizations.
• Generates administrative denial letters timely as per PHC Policy and Procedure
• Validates member and driver information necessary to process gas mileage reimbursements
• Documents all cases opened for Transportation in the appropriate platform or database, asper protocol.
• Routes calls as appropriate in a courteous and professional manner from the ACD phone line in the transportation call center.

Secondary Duties and Responsibilities

• Serves as departmental back-up as directed by Manager/Director.
• Participates in special projects and assignments as required
• Working knowledge and understanding of health plan structure and program requirements.

Qualifications

Education and Experience

High School diploma or equivalent required. One (1) year experience in the medical/clerical field; or equivalent combination of education and experience. Experience in phone based customer service.

Special Skills, Licenses and Certifications

Excellent oral communication with problem solving skills. General knowledge of managed care. Ability to work within an interdisciplinary team structure and function in a fast-paced environment while managing multiple priorities and meeting deadlines. Strong organizational skills required. Effective telephone and computer data entry skills required. Ability to access data and information using automated systems. Bilingual skills in Spanish, Tagalog, or Russian are preferred.

Performance Based Competencies

Excellent written and verbal communication skills. Ability to follow established procedures and protocol. Ability to communicate effectively with coworkers, physicians, and health care providers.

Work Environment And Physical Demands

Daily use of telephone and computer for most of the day. Standard cubicle work station with a shared common area. Ability to use a computer keyboard. Must be able to lift, move, or carry objects of varying size, weighing up to 10 lbs.

All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

HIRING RANGE:

$27.56 - $32.38

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.