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.
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.
COMPANY: KAISERTITLE: Medical Transportation AnalystLOCATION: Downey, CaliforniaREQNUMBER: 1275410External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.