Access to Care Specialist at PacificSource

Posted in Other 28 days ago.

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Location: Portland, Oregon

Job Description:
Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Position Overview: Maintain positive public relations with individual providers, provider groups and clinic administrators. Communicate via telephone and email to determine and monitor provider capacity levels and obtain other pertinent provider data in regard to network adequacy and access. Provide support and critical judgment/decision making on network adequacy and provider capacity to enterprise-wide Provider Network, Medicaid, and Compliance. Responsible for identifying, reporting on, and internally communicating network adequacy, capacity and access, identifying gaps, and defending exceptions. Maintain standardized reports, manage dashboards, communicate updates, and report findings within PacificSource and to external entities including but not limited to the Oregon Health Authority (OHA). Develops and/or updates policies and procedures related to duties. This position requires a high level of accuracy, communication, attention to detail and accountability.

Essential Responsibilities:
  • Develop positive working relationships with individual providers, provider groups and their staff to monitor capacity and access information through outbound phone calls and via email.
  • Act as a liaison for PacificSource between providers and various PacificSource departments.
  • Make decisions and recommendations on investigation of questionable/ambiguous data for reporting and data accuracy.
  • Responsible for providing prompt, courteous customer service to PacificSource personnel and all outside contacts. Support PacificSource decisions by being consistently helpful, confident and pleasant while working with a wide variety of personalities.
  • Develop access review protocols, best practices, and processes across multiple teams within Provider Network.
  • Maintain an organized tracking system of all findings/recommendations and resulting changes and corrections.
  • Participate in external audits as required.

Supporting Responsibilities:
  • Participate in department training and meetings as needed to become cross-trained and proficient in other areas of the department.
  • Meet department and company performance and attendance expectations.
  • Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  • Perform other duties as assigned.

Work Experience: Two years of experience in a closely related health insurance area required. Experience using spreadsheets to develop reports required. Analytics experience also preferred.

Education, Certificates, Licenses: High School diploma or equivalent.

Knowledge: Ability to critically review and interpret complex materials and make recommendations. Excellent public relations skills. Expert spreadsheet modeling and analytical ability essential. Fast and accurate data entry skills. Ability to prioritize work. Organizational skills. Self-motivation. Effective written and oral communication, including diplomacy skills for working with the medical professional community as well as internal customers.

  • Adaptability
  • Building Customer Loyalty
  • Building Strategic Work Relationships
  • Building Trust
  • Continuous Improvement
  • Contributing to Team Success
  • Planning and Organizing
  • Work Standards

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time.

Our Values
  • We are committed to doing the right thing.
  • We are one team working toward a common goal.
  • We are each responsible for customer service.
  • We practice open communication at all levels of the company to foster individual, team and company growth.
  • We actively participate in efforts to improve our many communities-internally and externally.
  • We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.