Transportation Specialist I

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.
• Contact 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 Partnership 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, as per protocol.
• Routes calls as appropriate in a courteous and professional manner from the ACD phone line in the transportation call center.

Qualifications

• 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.

Working Conditions

• 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.