Overview:
To coordinate member Non-Emergency Medical (NEMT) Transportation, Non-medical Transportation (NMT) transportation and related travel benefits for members.
Responsibilities:
Effectively communicate written and verbally with both members and providers.
Works directly with members, transportation providers and facilities to coordinate appropriate level and timeliness of transports within the DHCS guidelines and PHC policies.
Support and assist members in the resolution of problems with their transportation or travel benefits.
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.
Retrieves TAR information from PHC electronic systems, phone or paper format as per policy.
Verifies member’s eligibility and determines level of program benefit.
Elicit medical information from provider, consulting with HS/UM Clinical Staff as appropriate.
Contacts provider, verbally and/or in writing to pursue needed information.
Generates administrative denial letters timely as per PHC Policy and Procedure.
Working knowledge and understanding of health plan structure and program requirements.
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 and Responsibilities
Serves as departmental back-up as directed by Manager/Director.
Participates in special projects and assignments as required
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:
$ 24.
02 - $ 27.
62
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.
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