Summary: The primary responsibility of this role consists of reviewing member transportation requests that are over the contractual mileage guidelines.
ESSENTIAL FUNCTIONS
-
Reviewing and making approval/denial determinations for all member transportation requests that are outside of the geographical mileage guidelines and reviewing requests to non-covered Medicaid services and or locations.
-
Review for approval/denial determinations for facilities wishing to participate in the organization’s Subscription/Standing Order Transportation Program.
-
Process subscription/Standing order transportation requests from approved facilities for NEMT.
-
Investigates transportation provider complaints lodged against Medicaid members during transportation and issuance of Member Warning Letters as warranted.
-
Responsible for completing the three departmental reports: daily denial letters, member no-show letters, and monthly denial summary.
-
Run Monthly Denial Summary Report for covered regions and send to the client.
Required Skills and Abilities
-
Knowledge of Medicare and Medicaid, community resources, dialysis, and the nursing home placement process.
-
Must possess entry to mid-level proficiency in Microsoft Word and Excel.
-
Excellent written and verbal communication skills.
-
Possesses and demonstrates multi-tasking skills in a high-stress environment while working with multiple internal departments, as well as external entities.
-
Analytical thinker with good judgment.
-
Well-organized, self-directed individual, who is flexible and takes direction well.
-
Possesses a high level of interpersonal skills to handle sensitive and confidential situations.
Minimum Required Education/Training
-
High School graduate or equivalent.
-
2 years of customer service experience and or employment in the healthcare industry.
