Transportation Specialist I - Monday - Friday 10:30am - 7:00pm

About the role

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

Secondary Duties

• 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.

Requirements

• 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.

Skills

• 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.
• 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

• 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 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.

Pay

$28.52 - $33.51 per hour