Managed Care Coordinator

Oregon Health & Science University•Portland, OR

3d•Onsite

About The Position

The Managed Care Coordinator (MCC) at Richmond Family Medicine Clinic is responsible for handling all aspects of the authorization process. The MCC processes incoming and outgoing department referrals along with prior authorizations for diagnostic services. This will include gathering appropriate and correct patient demographics, financial information, chart notes and other supporting documentation, and confirming correct health coverage.

Requirements

One year of experience in a medical office setting, including high-volume direct patient contact, scheduling of appointments and may require experience obtaining managed care authorizations (dependent on position description). OR one and a half years of work experience in a high volume direct public contact position and 6 months experience in a medical office setting.
Thorough knowledge of PAS policies and procedures.
Demonstrated advanced PAS user skills as well as extensive knowledge of integrated care at OHSU.
Basic computer skills including word processing.
Windows applications, on-line scheduling, and a preference for data-base skills.
Excellent verbal and written communications skills.
Strong customer service orientation.
Demonstrated effectiveness in confrontational customer interactions.

Nice To Haves

High school diploma or equivalent.
Previous Epic experience.

Responsibilities

Manages referral work queues and processes - communication, scheduling, and prior authorization - for LARC, OB, and specialty clinic appointments.
Responsible for verifying patient eligibility and securing referral/authorization prior to the outpatient appointment.
Gathers and/or verifies patient information including demographics, insurance coverage, and financial status.
Confirms patient eligibility for health care coverage.
Obtains prior authorizations for clinical care, procedures and diagnostic studies as appropriate.
Enters all information accurately into Epic.
Follows up on pending authorizations until they are obtained.
Updates referral work queue.
Maintains current information on all managed care insurance plans and is up-to-date with all managed care insurance plan changes, utilizing information to efficiently and effectively obtain authorizations.
Serves as a liaison and information source for other department support staff, department physicians and referring providers/offices, OHSU Health Plan Office, patients, and insurance companies for authorization requirements per diagnosis and service type.
Provides back-up support for referral coordinators.
Fills in as needed for any business position within the service areas, including but not limited to template building and maintenance.
Maintains a service based working knowledge of diagnostic and procedural coding.
Communicates with patients/families, other health care team members, in a time and cost efficient, courteous manner.
Demonstrates active listening skills and supportive, professional behavior at all times, to patients, families and staff.
Documents all care given, observations, and patient response to care, accurately and legibly in English, in the medical record.
Back up for answering phones and scheduling appointments as necessary; additional coverage for front desk duties as needed.