PAS Resource Specialist

Oregon Health & Science University•Portland, OR

5d•Hybrid

About The Position

This position is an integral part of the Department of Urology at OHSU, which is committed to providing the highest quality, state-of-the-art care for adult and pediatric urology patients. The role directly supports the Department's objectives of Clinical Care, Quality Assurance, Education, and Research. The position is responsible for scheduling surgeries and related clinic visits, obtaining insurance authorization, conducting managed care activities, assisting with referral management, and triaging incoming calls, all while maintaining the highest standards of customer service excellence.

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.
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

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

Responsibilities

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).
Schedule new surgical and clinical appointments via EPIC Cadence.
Arrange wheelchairs, interpreters, and transportation when necessary and accommodate other special needs.
Prepare and mail information packets to patients, notify patients of appointments via telephone and mail, and make confirmation calls and send out appointment reminders.
Make special arrangements with families for teleconferences as needed.
Secure 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 ensure a smooth referral process.
Participate in meetings and committees as requested to improve patient care processes and procedures.
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 and obtain authorizations for clinical care, surgeries, procedures, and laboratory studies.
Enter all authorizations, referral and benefit information accurately into EPIC Cadence and EARL.
Follow up on pending authorizations until they are obtained.
Work 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 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 arrangements that need to be made to consult with the patient.
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.
Perform other duties as assigned.