Virginia Premier Health Plan, Inc.

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Transportation Review Specialist

Transportation Review Specialist

Job Locations 
US-VA-Glen Allen
Job ID 
2017-4356

Job Description

Overview

POSITION OVERVIEW

This position requires a complete understanding of the transportation process from member reservation to member transport to transportation vendor payment. Incumbent will be responsible for the mileage reimbursement program.  The Review Specialist will obtain from healthcare facilities all information required to manage subscription trips.  Representative will also maintain up to date information on program attendance by member and will cross reference actual attendance with trip reservations The incumbent will be responsible for eligibility determination, verifying appropriateness of trip type, payment, denials, payment resubmissions, long distance monitoring and confirming utilization of the closest medical provider of services.  Representative will review a variety of reports and records to identify unusual and/or suspicious patterns and report suspected fraud and abuse.

Responsibilities

POSITION DUTIES AND RESPONSIBILITIES

  • Distribute transit tickets (via mail or driver delivery when appropriate) and track utilization
  • Evaluate all long distance trips looking for opportunities to refer to closer providers or divert to lower cost modes (vendors or reimbursement)
  • Validate Day Program Attendance
  • Enter subscription Trips
  • Cancel trips of ineligible members
  • Process mileage reimbursement paperwork, update member information, verify appointment attendance and submit reimbursements to finance
  • Match waiver list to member transports
  • Maintain unaccompanied minor transport authorizations
  • Identify the appropriate mode of transportation for members
  • Determines the appropriateness of transportation requests by interacting with medical facilities, clinicians, physicians and internal staff
  • Other duties as assigned

Qualifications

MINIMUM EDUCATION REQUIREMENTS

  • High school graduate with superior communication skills; strong time management skills; excellent problem solving skills; computer proficient ; good written and oral communication skills; ability to work independently or with a team.

SPECIAL KNOWLEDGE AND/OR SKILLS

  • Proven experience in Call Center, Transportation or other operational area
  • Proven experience in research and investigation of facts
  • Strong spreadsheet and database skills
  • Excellent attention to detail
  • Ability to work independently while managing multiple tasks
  • Good organization skills and the ability to prioritize task

PHYSICAL REQUIREMENTS

  • Physical health sufficient to meet the ergonomic standards and demands of the position.

 

 

About Us

Virginia Premier Health Plan, Inc. is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs.  Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 

 

We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  

 

All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

 

Our mission is to inspire healthy living within the communities we serve!

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