Job Abstract

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.

• 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.