Performs prospective review, ordering, analysis and reporting of KP medical transports. Interacts with staff and physicians to answer inquiries and educate on covered benefits. Interacts with staff and members in pre-service denials processing.
Records patient demographic and medical information and reports the information to designated medical transportation dispatching. Essential
Reviews physician and staff request for benefit-covered medical ambulance service. Ensures that information is documented and reported following appropriate guidelines and procedures. Utilizes various data systems to obtain the medical transportation program information and to produce contractual and utilization reports as requested.
Investigates medical transports that are completed inappropriately to determine the cause, to problem solve, and to notify the Medical Transportation Supervisor. Demonstrates awareness of and adherence to policies, procedures, and requirements of regulatory agencies. Responds to requests for medical ambulance service through designated dispatching areas in an accurate and timely manner.
Issues as appropriate pre-service Notice of Non-Coverage letters in accordance with regulatory requirements. Provides supporting documentation and distributes letters to the appropriate individuals and/or agencies. Verifies health plan membership status.
Attends mandatory department meetings and performs miscellaneous duties as assigned by the Medical Transportation Supervisor. Qualifications
Experience Minimum six (6) months experience required in a health-care related field. Per the National Agreement, current KP Coalition employees have this experience requirement waived. Education High School Diploma or General Education Development (GED) required.
License, Certification, Registration N/A Additional
Ability to effectively coordinate multiple tasks. Working knowledge of medical terminology required. Excellent verbal and written communications skills.
Strong customer service skills. Must be able to work in a Labor/Management Partnership environment.
EMS or hospital dispatch experience. Knowledge of PC and Kaiser mainframe systems. Knowledge of KFHP coverage benefits, state, federal and local regulatory agency requirements.
Notes: This is a temporary position for approximately three (3) months. Rotating weekends Scheduled Weekly Hours: 40
Day Workdays: Sun, Mon, Tue, Wed, Thu, Fri, Sat Working Hours Start: 09:00 AM Working Hours End: 05:30 PM Job
Full-time Job Type: Standard Employee Status: Temporary Worker Location: Onsite Employee Group/Union Affiliation: B01|SEIU|Local 399 Job Level: Individual Contributor Department: Tustin Executive Center - Cost/Bene-Ambulance Hub Ops - 0808
$28.61 - $30.65 / hour Travel: No