TRANSPORTATION PROVIDER OMBUDSMAN - WI

LOCATION:ON-SITE IN MADISON, WI

POSITION CONTINGENT UPON AWARD OF CONTRACT

SUMMARY

Serves as the primary liaison and advocate for contracted transportation providers, supporting the development, stability, and performance of a responsive, high-quality provider network throughout Wisconsin. Evaluates network capacity and implements strategic initiatives to ensure sufficient provider resources are available to meet operational demands across all mobility levels and service areas. Collaborates with Operations, Compliance, and regional stakeholders to support provider credentialing, training, orientation, compliance, and performance improvement efforts. Facilitates provider engagement, addresses concerns, resolves operational issues, and promotes the fair and consistent application of network policies, contractual requirements, and service standards.

ESSENTIAL FUNCTIONS

• Serve as the primary point of contact and advocate for contracted transportation providersregardingoperational concerns, contract interpretation,reimbursementmatters, service expectations, and network participation.
• Establish andmaintainpositive working relationships with transportation providers to support provider engagement, retention, satisfaction, and network stability.
• Participate in provider contracting activities, including reimbursement model development, fee schedule evaluations, rate negotiations, contract administration, and coordination with Finance and executive leadership.
• Maintainaccurateand current provider profiles, databases, and records, including service areas, vehicle inventories, operational capabilities, reimbursement information, and contract documentation.
• Coordinate provider recruitment efforts to address network adequacy needs, capacity challenges, service gaps, and member service concerns across all mobility levels and service regions.
• Support provider onboarding activities, including application processing, credentialing, orientation, training coordination, and distribution of provider manuals, policies, and educational materials.
• Collaborate with Compliance, Quality Assurance, Network Development, and Operations teams to ensure providers meet contractual, credentialing, performance, and regulatory requirements.
• Monitor provider performance trends, member feedback, complaint activity, and operational metrics;facilitateissue resolution and support corrective action planning when necessary.
• Coordinate the investigation and resolution of provider-related complaints, service disruptions, escalations, and operational concerns to promote service quality and provider satisfaction.
• Contribute to network adequacy planning byidentifyingrecruitment opportunities, regional coverage needs, providercapacity challenges, and service improvement initiatives.
• Represent provider perspectives during internal planning discussions and strategic initiatives while supporting contractual obligations, Department requirements, and organizational goals.
• Assistin the development, maintenance, and communication of provider resource materials, policies, procedures, and program updates.
• Ensure compliance with company policies, contractual requirements, and applicable regulatory standards.
• Participate in organizational planning, provider satisfaction initiatives, and continuous improvement efforts designed to strengthen network performance and service delivery.
• Perform other duties as assigned.

QUALIFICATIONS REQUIRED

• Excellent verbal, written, presentation, and interpersonal communication skills with the ability to effectively engage transportation providers, internal stakeholders, leadership, and external partners.
• Strong relationship-building, diplomacy, and customer service skills, with the ability to foster collaboration, resolve concerns, andmaintainproductive provider partnerships.
• Experience interpreting provider contracts, reimbursement methodologies, operational requirements, and network policies.
• Ability to analyze provider data, demographic information, performance metrics, capacity trends, complaint activity, and operational reports to support decision-making and network improvement initiatives.
• Strong problem-solving, critical-thinking, and professional judgment skills with the ability to address complex provider and operational issues effectively.
• Proficiencywith Microsoft Office Suite, provider management databases, reporting tools, and other business applications.
• Ability to work independently while effectively coordinating activities across multiple departments and stakeholder groups.
• Strong organizational skills with attention to detail and the ability tomaintainaccurateprovider records, documentation, and reports.
• Professional appearance, positive attitude, and commitment to delivering high-quality provider support and service.
• Ability and willingness to travel extensively within the assigned service area, with travel requirements ofapproximately 40–50%.
• Valid driver's license and clean driving recordrequired.

MINIMUM REQUIRED EDUCATION:

Bachelor’s Degree in Business, Healthcare Administration, Transportation Management, or a related field; or equivalent experience may be considered.

3 years of experience in provider contracting, network management, or transportation operations.

Prior experience with NEMT, Medicaid programs, or regulated transportation services preferred.

Proven contract preparation skills with an in-depth knowledge of reimbursement methodologies.