Medical Transportation Analyst UHW

Kaiser Permanente; Tustin (CA); On-site; USD 42,000 - 63,000; Full time

Benefits offered by this job

On-site

Rotating weekends

Job summary

Kaiser Permanente is seeking a Medical Transport Policy Specialist to perform prospective review, ordering, analysis and reporting for KP medical transports. You will interact with staff and physicians to answer inquiries, educate on covered benefits, and process pre-service denials.

This role involves patient demographics and medical information handling with dispatching teams. The position is temporary (about three months) with rotating weekends, 8 hours per day, 5 days per week, on-site at

Qualifications

• Six months of experience in a health-care related field.
• High School Diploma or GED is required.

Responsibilities

• Reviews requests for benefit-covered medical ambulance service.
• Documents and reports information per guidelines and procedures.
• Utilizes data systems to obtain program information and produce reports.
• Investigates mis-transports to determine cause and inform supervisor.
• Ensures adherence to policies and regulatory requirements.
• Responds to dispatch requests accurately and timely.
• Verifies health plan membership status.
• Attends mandatory department meetings and performs duties as assigned.

Skills

Multitasking

Medical terminology

Customer service

Verbal communication

Written communication

Education

High School Diploma or GED

Tools

KFHP mainframe

PC knowledge

Job description

Job Summary:

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 Responsibilities:

• 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.

Pay Grade: 36

Basic 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 Requirements:

• 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.

Preferred Qualifications:

• 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, 8 hours p/day, 5 days p/week, On-site Tustin Executive Center.