Managed Care Coordinator Pre Float (PAS Resource Specialist) - Oregon Health & Science University

Department Overview:

Clinical Transplant Services website https://www.ohsu.edu/transplant. Clinical Transplant Services is part of an inter-disciplinary team that coordinates and provides pre-transplant and post-transplant services. Our outpatient department includes support staff, Managed Care Coordinators, RNs, Social Workers, Financial Counselor support, and a Quality team. Our transplant programs include liver, kidney, pancreas, living donor kidney, and heart.

 

This position is responsible for providing administrative support for Clinical Transplant services. It is a Pre Float position that combines duties of a Referral Coordinator and Managed Care Coordinator. Orientation on site. After orientation: Hybrid position including on site and remote work.

Function/Duties of Position:

Manages Care Coordination:

• Maintains current information on managed care insurance plans and serves as a liaison and information resources for physicians, nursing support staff, and coworkers, referring physician offices, OHSU Health Plan Office, patients, and insurance companies on authorization requirements per diagnosis and service. Serves as service area expert on coding requirements and issues.
• Obtains managed care authorizations for all consultations, procedures, office visits, and care arrangements by scheduling appointments and contacting other ancillary and clinical services as needed, while considering fiscal impact. Collects from physicians all information necessary for authorizations and appeals.
• Obtains authorizations for listing and transplant surgery. Applies problem solving and negotiating skills in resolving patient concerns and managed care related problems.

Evaluation Scheduler

• Maintains current information regarding pre-transplant evaluation schedules for service site providers. Serves as liaison and information resource for physicians, nursing support staff, and coworkers. Applies problem solving and negotiating skills in resolving provider and patient concerns and other scheduling related problems.

Enrollment & Authorization:

• Gathers and/or verifies patient information including demographics, insurance coverage, and financial status. Confirms patient eligibility for health care coverage and clarifies any managed care arrangements. Obtains authorizations for clinical care, procedures, and laboratory studies.
• Enters all information accurately into OHSU databases or into the medical record when necessary. Follows up on pending authorizations until they are obtained.

Required Qualifications:

• 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. 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. 
• 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.

Knowledge and Skills Required:

• 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.

Preferred Qualifications:

• High School Diploma or GED
• Prefer BS or BA in any area.
• Whole organ transplant medical office experience. 
• EPIC Phoenix experience.
• Medical protocol processing experience.
• Laboratory data entry experience. 
• Advanced EMR management.
• Advanced computer keyboarding skills.
• Epic Referrals & Cadence.

Additional Details:

Ability to work general business office hours, hours: Monday through Friday, 8 AM - 5 PM.  Occasional need to come in early or stay late to accommodate patient or physician needs. Ability to work in shared office space with multiple distractions and general noise from phone calls.  Hybrid position including on site and remote work.

All are welcome: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.