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 - Pain Center
US-OR-Portland
Job ID: 2023-26274 Type: Regular Part-Time # of Openings: 1 Category: Hospital/Clinic Support Portland, OR (Waterfront)
Overview
Customer service excellence and Telecommunications
At all times must exemplify high quality customer service to both external customers as well as internal customers that meets or exceeds the service standards as set by OHSU. This includes communications with patients, referring providers, insurance carriers, and OHSU staff. This duty includes prompt and professional communication efforts, face-to-face customer contact skills, high-level conflict resolution and response to customer concerns, flexible coverage of internal service needs, continuous application of process improvement methods and skills.
This position will receive incoming phone calls via the Automated Call Distributor (ACD) and will document accurately telephone communications into Epic using Standard Work. Consistently answer telephones in a timely manner and within defined standards.
This position will proactively perform outbound call work to patients to communicate status of their insurance coverage, explaining any insurance complications for scheduled appointments, and document into Epic.
Benefits and Authorizations, Managed Care coordination, Surgery Scheduler, Scheduling
Gathers and verifies patient information including demographics and insurance coverage. Confirms patient eligibility for health care coverage. Obtains authorizations for clinical care, procedures, and surgical cases. Accurately documents each step of workflow into Epic following Standard Work. Follows up on pending authorizations until they are obtained. Communicates with patients and providers the status of pending authorizations or other insurance coverage concerns.
Schedules patients for appointment as needed in order to coordinate care or to ensure authorization can be obtained for services.
Maintains current information on managed care insurance plans and serves as an information resource to providers and CPC staff.
Ensures check-in staff have all information and documents in place for a smooth, efficient, and complete check-in process. This includes, but is not limited to, careful review of insurance and demographic information with each patient and verifying insurance benefits, obtaining authorization, indicating information on copays, deposits, estimates, forms such as ABNs, NCCFs, OHP waivers. Clarifies questions from Scheduling staff regarding insurance coverage for scheduling. Communicates with patients and check-in/scheduling staff (Comprehensive Pain Center, ENT, and Beaverton CCI) when questions or discrepancies arise. Communicates with providers if there are concerns about coverage for requested services or orders.
Obtains authorization for CPC surgical cases, and schedules surgical cases. Coordinates visits needed prior to surgery and post-surgery including scheduling preops, PMC clinic, ancillary services, and post-op appointments as needed. Applies problem solving skills in resolving provider and patient concerns related to surgical cases.
Integrated Care, Communication, Workqueues, Information Resource
Process all Managed Care work queues for obtaining authorizations for procedures (Surgery WQ), diagnostic testing (Diagnostic WQ), outgoing referrals (From my Practice WQ), patient estimates and notification of service pricing (No Surprise Billing WQs), and other workqueues as needed, while assessing the patient’s needs based on diagnosis, insurance coverage and medical records.
Maintains up to date and current on information on managed care insurance plans, and serves as a liaison and information resource for clinical staff, colleagues and insurance companies regarding insurance coverage and processes. Applies problem solving skills in working with insurance companies, FPP and Hospital Financial Services in resolving patient concerns and billing related problems. Responds to patient, staff and provider questions regarding insurance coverage.
Will monitor and respond to inbasket messages, emails, and faxes following Standard Work and within timeframes consistent with performance metrics.
Will monitor inquiries and communications with colleagues and providers using messaging platforms such as Microsoft Teams, responding withing reasonable timeframes and customer services expectations.
Other duties as assigned
Responsibilities
High School Diploma or GED
At least one year of experience in an ambulatory clinical setting. Including high-volume scheduling of appointments, multi-line phone system, obtaining managed care authorizations..
Must have thorough knowledge of PAS polices and procedures, and demonstrated advances PAS user skills.
Advanced computer skills, including Microsoft Word and Excel , OHSU Epic skills and online resource use knowledge.
Excellent communication skills, both written and verbal
Demonstrated knowledge of managed care policies and procedures including appropriate timelines, paperwork, regulations, communication and follow-up are also required.
Demonstrated efficiency, problem solving and negotiation skills in resolving patient concerns and managed care related problems.
Must meet Department performance standards measuring efficiency, production, timeliness and accuracy. This will be reviewed on a regular basis both as a team and as an individual.
Ability to multi-task in a high volume situation.
Strong attention to detail and processes
Ability to work autonomously, with a high level of accuracy, speed and exhibit a willingness to work with deadlines.
Qualifications
AA degree or some college coursework.
OHSU experience preferred
Prefer the candidate have a thorough knowledge of referral processes in EPIC.
Prior experience with surgery scheduling.
Experience with electronic scheduling, and electronic medical record systems preferred.
