TRANSPORTATION PROVIDER OMBUDSMAN - DC
About The Position
The Provider Relations and Beneficiary Advocate is responsible for developing and maintaining a high-performing, compliant provider network while serving as an independent advocate for beneficiaries receiving Non-Emergency Medical Transportation (NEMT) services. This role evaluates provider network capacity, implements strategic initiatives to ensure adequate transportation resources across all mobility levels, and collaborates with regional, compliance, and operations teams to support provider credentialing, training, orientation, and ongoing development. The position also investigates, facilitates, and resolves beneficiary concerns and complaints by working collaboratively with providers, internal stakeholders, and the District to ensure timely, fair, and effective resolution of service issues. This role operates with impartiality, free from conflicts of interest or undue influence, while promoting service excellence, regulatory compliance, and a positive beneficiary experience.
Requirements
- Excellent presentation, verbal, and written communication skills.
- Above average Microsoft Office skills.
- Ability to work independently or with a team.
- Ability to accurately compile and produce Provider demographic information.
- Professional appearance; positive attitude.
- Able to travel = 40-50%.
- Clean driving record.
- Proven contract preparation skills with an in-depth knowledge of reimbursement methodologies.
Responsibilities
- Participates in fee schedule determination including development of reimbursement models; negotiates agreements with Providers in accordance with defined rate structures.
- Seeks approval on new reimbursement models from Corporate Finance Management.
- Maintains accurate Provider profiles/databases.
- Establishes and maintains a positive working relationship with NEMT providers.
- Targets and recruits additional providers to reduce member complaints.
- Assists with monitoring contracts, reimbursement schedules.
- Coordinates NEMT provider application, credentialing, and orientation.
- Assists with the development and maintenance of provider informational materials and manuals.
- Assists with NEMT Provider compliance activities, as needed.
- Participates with the management team addressing the strategic goals of the organization.
- Ensures compliance with all company policies and practices.
- Other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
