Job Description:
Oregon Health & Science University

Oregon Health & Science University values a diverse and culturally competent workforce. We are proud of our commitment to being an equal opportunity, affirmative action organization that does not discriminate against applicants on the basis of any protected class status, including disability status and protected veteran status. Individuals with diverse backgrounds and those who promote diversity and a culture of inclusion are encouraged to apply. To request reasonable accommodation contact the Affirmative Action and Equal Opportunity Department at 503-494-5148 or aaeo@ohsu.edu.


PAS Resource Specialist

US-OR-Portland

Job ID: 2024-31883
Type: Regular Full-Time
# of Openings: 1
Category: Hospital/Clinic Support
Portland, OR (Waterfront)

Overview

Customer Service: Provide the highest level of customer service to both external customers (patients and their families, referring providers, insurance carriers, etc.) and internal customers (OHSU health care providers and staff) that meet or exceed the service standards of the health care industry. This duty includes prompt and professional communication efforts, face-to-face customer contact skills, crisis management, facility with available information technology, standard complaint processing, flexible coverage of internal service needs and the continuous application of process improvement methods and skills.

Surgery Scheduling: Schedule new surgical and clinical appointment via EPIC Cadence. Arrange wheelchairs, interpreters, and transportation when necessary and accommodates other special needs whenever possible. Prepares and mails information packets to patients. Notify patients of appointments via telephone and mail. Make confirmation calls and send out appointment reminders. Make special arrangements with families for teleconferences as needed. Secures pertinent outside medical records prior to appointments including hard copies of appropriate diagnostics. Schedule diagnostic studies to be done at facilities inside and outside of OHSU. Arrange for transfers of patients from outside hospitals via the transfer center, per surgeon instructions. Develop and maintain working relationships with the referring physician and their staff to insure a smooth referral process. Participate in meetings and committees as requested to improve patient care processes and procedures.

Managed Care: Gather/Verify patient and guarantor information including demographics, insurance coverage, and financial status; confirm patient eligibility and benefits for health care coverage directly with the carrier via electronic database, phone, fax or email; clarify any managed care arrangements; obtain authorizations for clinical care, surgeries, procedures and laboratory studies. Enter all authorizations, referral and benefit information accurately into EPIC Cadence and EARL. Follows up on pending authorizations until they are obtained. Works with manager to resolve any denials related to authorization/enrollment issues in a timely manner.

Follow up on referrals for future appointments. Attend monthly managed care meetings and share information with staff. Serve as liaison and information resource for physicians, nursing support, coworkers, referring physicians, etc. on insurance authorization requirements. Determine appropriate TOS payment amounts (including co-pays, co-insurance, deductibles, deposits, prepayments, etc.) and arrange for their collection at the time of service. Arrange for T&C forms, NCCF, etc. to be completed by patient and submit as appropriate. Apply problem solving skills and negotiation skills in resolving patient concerns and managed care related problems. Follow up on UMG denials as requested by manager. Perform other miscellaneous tasks relating to the managed care processes at OHSU.

Process Incoming referrals: Process all incoming referrals both internal and external using the department of Urology’s Referral Matrix. Gather all pertinent medical records for consultation. Direct referrals to medical personnel on medical review and scheduling recommendations. Communicate with referring providers on authorization and other arrangement that need to be made in order consult with the patient.

Telecommunications: Triage incoming calls and route callers to appropriate provider, staff or resource; accurately document and relay any messages; process any requests for medication refills as directed by provider; direct calls of complaint, requests for information, urgent health care concerns and general inquiries to the appropriate source.

Other Duties As Assigned.

Responsibilities

• One year of experience in a medical office setting, including high-volume direct patient contact, scheduling of appointments and obtaining managed care authorizations.
• The candidate must have a thorough knowledge of PAS policies and procedures.
• Candidates will have demonstrated advanced PAS user skills as well as extensive knowledge of integrated care at OHSU.
• Proficient with managed care functions including eligibility issues, authorizations, referrals and TOS payments/collections.
• Demonstrated exemplary written and verbal customer service skills and communication skills.
• Strong customer service orientation.
• Demonstrated effectiveness in customer confrontational interactions.
• Basic computer skills including word processing.
• Windows applications, on-line scheduling, and a preference for data-base skills.
• Must have excellent attendance; must be detail oriented and must be able to demonstrate ability; must be able to work independently, with little direct supervision; must have demonstrable record of reliable attendance, punctuality, and proven successful performance at past and present employers.

Qualifications

• Bachelors degree or some college experience.
• Two years experience in a high volume medical office.
• Experience in a Urology service.
• OHSU PAS experience.
• EPIC experience.

PI251379187

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