Transportation Network Representative

Inland Empire Health Plan•Rancho Cucamonga, CA

12d•$27 - $36•Hybrid

About The Position

The Transportation Network Representative serves as the frontline field role and primary point of contact for transportation providers and facilities. This position is responsible for provider coaching, training, onboarding, and enforcing performance standards to ensure service quality and compliance. Key responsibilities include executing audits and inspections, coordinating facility liaison activities, and managing scheduling and trip-level triage to maintain timely and accurate transportation services. The role also involves conducting member and provider outreach, preparing accounts payable evidence packages, maintaining thorough documentation, and supporting Voice of Member initiatives to enhance the overall experience. Success in this position requires strong organizational skills, attention to detail, and the ability to build effective relationships with providers and facilities to uphold compliance and deliver exceptional member care. Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Requirements

Three plus (3+) years of experience in a combination of transportation operations, provider relations, and/or healthcare network coordination
Experience training and onboarding providers on operational processes and compliance standards
Field-based work experience with clear policy communication skills
High School Diploma or GED required
Must have a valid California Driver’s license and valid automobile insurance.
Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points
Knowledge and understanding in the following areas: NEMTAC standards and competency guidelines
Healthcare compliance standards, including CMS, DHCS, DMHC, and Medi-Cal transportation benefit regulations
Provider performance management frameworks, including scorecards and action improvement plans
Dispatch optimization principles and trip assignment best practices
Standard operating procedures for Standing Orders (STO), PCS forms, and credentialing enforcement
Basic principles of billing integrity and fraud detection protocols
Strong understanding of transportation workflows and the impact of missed or delayed trips on member experience
Intermediate proficiency in Microsoft Excel (pivot tables, VLOOKUP) and Word (policy documentation)
Ability to run and interpret trip-level and provider performance reports
Familiarity with scheduling and dispatch platforms for trip assignment optimization
Competence in using data analysis tools for KPI tracking and VoM analytics
Basic knowledge of AP processes and assembling billing evidence packages
Familiarity with provider portals and/or dispatching software
Strong analytical and documentation skills for audits, billing investigations, and compliance
Strong communication skills for policy interpretation and provider coaching
Ability to build effective relationships with providers, facilities, and internal teams
Problem-solving skills to resolve trip-level issues and operational challenges under time constraints
High adaptability and organizational skills for managing multiple priorities in a fast-paced environment
Attention to detail to ensure accurate documentation and compliance readiness
Proven ability to collaborate with cross-functional teams, including AP, Finance, and Operations

Nice To Haves

Experience supporting managed care claims, encounters, and billing dispute resolution
Background in high-volume, operationally complex environments with multiple vendor relationships
Contribution to Voice of Member (VoM) or Customer Experience (CX) initiatives, including accurate tagging, issue categorization, and supporting closed-loop improvements
Associate’s degree in Healthcare Administration, Business Administration, or a related field from an accredited institution preferred
Passenger Assistance, Safety and Sensitivity (PASS) Certification from the Community Transportation Association of America (CTAA) preferred
Familiarity with IEHP transportation policy, Medi-Cal regulations, and NEMT authorization processes preferred

Responsibilities

Serve as the primary point of contact for assigned transportation providers and facilities.
Conduct at least 10 proactive, meaningful engagements per provider/facility annually to strengthen relationships and ensure compliance.
Respond and resolve issues within established Service Level Agreements, log all interactions with complete details (provider ID, reason, priority, disposition, artifacts), and escalate safety, compliance, or contractual concerns to the Supervisor.
Maintain high-quality documentation for audits, Fraud, Waste, and Abuse investigations, and Accounts Payable processes.
Deliver provider coaching and training sessions, support onboarding activities, and enforce performance standards through structured engagements and action improvement actions.
Ensure providers understand compliance requirements and service expectations to maintain quality and reliability.
Perform unannounced live trip audits and virtual/in-person vehicle inspections.
Validate GPS and timestamp accuracy and provide improvement coaching when safety or compliance issues are observed to ensure member safety and regulatory adherence.
Act as the single point of contact for assigned facilities.
Assist with configuring Standing Orders (STOs) and sending PCS forms, train facility staff on booking and authorization processes, and promote portal adoption and compliance to improve operational efficiency.
Triage and resolve day-of exceptions such as late, missed, or disrupted trips.
Ensure on-time pickup and drop-off (OTP/OTD) and escalate safety or time-sensitive concerns per standard operating procedures (SOPs) to maintain service reliability.
Carry out outreach cadence (e.g., 60/30/15-day reminders) to contact members and clinical providers, obtain or refresh PCS forms and STOs, and capture and file documentation accurately to support continuity of care.
Assemble manifests, GPS logs, authorization records, and communications to resolve invoice discrepancies for Uber/Lyft and transportation providers, ensuring billing integrity and reducing AP rework.
Perform any other duties as required to ensure Health Plan operations and department business needs are successful.