Job Description

OVERVIEW:

Under the general supervision of the Supervisor of Operations, the COORDINATOR - UTILIZATION MANAGEMENT TRANSPORTATION (CALL CENTER) is responsible for reviewing transportation requests initiated by Providers/Members. The position requires the ability to multitask ensuring that the information on the request is correct and complete. Verifying the Doctor/Facility’s address matches the address in the system to ensure the Member is transported to the correct address, calling the Provider to verify appointments when necessary and ensuring that the Members are transported at the correct level/mode to ensure the Member’s safety. The Utilization Management Coordinator Transportation (Call Center) is responsible to monitor the Transportation authorization queue to ensure all Transportation requests are processed timely and are following standard regulatory requirements. The Coordinator - Utilization Management Transportation (Call Center) is responsible to communicate with the vendor that manages the Dual Choice Transportation Benefit to verify benefit exhaustion.

RESPONSIBILITIES:

• Responsible for reviewing and determining the need for transportation requests initiated by a Provider or the Member directly.
• Responsible for outbound calls to both Members and Providers to obtain the necessary information to determine the medical necessity of transportation requests.
• Collaborates with the Medical Directors for transportation requests that do not meet the criteria for a final decision.
• Ensures alerts are properly created for Members that meet the criteria for continued transportation.
• Monitors the Transportation authorization queue to ensure transportation requests are processed timely following all regulatory time frames.
• Responsible for covering the transportation Member phone queue as directed by management
• Responsible for covering the transportation Vendor phone queue as directed by management.
• Responsible for covering the Transportation LTC/SNF/Hospital phone queue as directed by management.
• Responsible for managing the incoming transportation requests through RightFax coming in from our LTC/ SNF facilities and hospitals.
• Other responsibilities not listed

Requirements:

• Two (2) years of customer service experience.
• Experience in data entry
• Customer service experience in medical clinics, hospitals, or IPAs preferred Managed care setting experience preferred.
• Experience in an HMO or managed care setting preferred, including Medicare Advantage health plan.

EDUCATION QUALIFICATIONS:

• High school diploma or GED required.
• Associate's degree from an accredited institution preferred.