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.
POSITION DUTIES AND RESPONSIBILITIES
MINIMUM EDUCATION REQUIREMENTS
SPECIAL KNOWLEDGE AND/OR SKILLS
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
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