The OHSU Department of Surgery is comprised of nine integrated yet independent surgery divisions: Abdominal Organ Transplantation, Bariatric, Cardiothoracic, Gastrointestinal and General, Pediatric, Plastic and Reconstructive, Oncology, Trauma and Acute Care and Vascular Surgery. Our department is built on a culture of community and a history of innovative and interdisciplinary collaboration. Our faculty are dedicated to excellence in education, research, scholarship and clinical practice. We also house one of the largest general surgery residency programs in the country and offer surgery fellowships in all of our disciplines. OHSU as a teaching hospital is fully supported by each of our faculty and staff.
Enrollment and Authorization: Verify patient information including demographics, insurance coverage and financial status. Confirm patient eligibility for health care coverage and clarify any managed care arrangements. Obtain authorizations for all clinical care, procedures, and laboratory studies, to include providers at onsite and offsite clinics. Enter all information accurately into OHSU databases. Follow-up on pending authorizations until they are obtained. In addition, integrate care by obtaining authorizations for other associated clinical diagnostic or laboratory services. Contact primary care physicians or their designees to obtain authorizations for urgent care. Facilitate Financial Assistance Policy applications, prepare documents for self-pay patients, and communicate payment expectations to patients prior to the time of service. Communicate time of service payment expectations to clinic front desk staff.
Managed Care Coordination: Maintains current information on managed care insurance plans and OSU/FPP financial policies. Serves as liaison and information resource for physicians, nursing support staff, coworkers, referring physician offices, patients and insurance companies on authorization requirements per diagnosis and service. Serves as service area expert on managed care, coding requirements and issues, along with providing communication to support staff of any and all new processes. Applies problem solving and negotiating skills in resolving patient concerns and managed care related problems, to include satellite clinics as applicable. In addition, establishes benefits, utilizes contract information, OHSU policies and insurance carrier policies on managed care, coordinates referrals and authorizations on line and interprets managed care benefits to patients. Updated skills and information through meetings and workshops is necessary maintaining documentation of efforts. Follow-up on UMG denials, using Resolute tools, as requested by manager. Customer Service: Provide high quality customer service to both external customers (patients, referring providers, and insurance carriers) and internal customers (OHSU health care providers and support staff) that meets and/or exceeds the service standards of the health care industry. Seeks opportunities to improve the work and work environment to better meet the needs of internal and external customers. This duty includes prompt and professional communication efforts, face-to-face customer contact skills, crisis management, facilitate with available information, technology, standard complaint processing, flexible coverage of internal service needs and the continuous application of process improvement methods and skills. Notifies patients of authorization results and notifies physician/nurse if patient requires self-pay information.
Other duties as assigned: Provide PAS Resource Specialist coverage for Department of Surgery practices.
One year of experience in a medical office setting, including high-volume direct patient contact, scheduling of appointments and requires 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.
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.
OHSU Epic skills and knowledge preferred.
Excel skills and knowledge preferred.
Understanding of CPT and ICD-10 codes.
Monday - Friday, 8:00am - 4:30pm. After a period of time may be able to telecommute.
We are Oregon's only public academic health center. In addition to caring for patients, we lead groundbreaking research. We also train the next generation of health care professionals. As Portland's largest employer, we give you opportunities to learn and advance in a system of hospitals and clinics across Oregon and Southwest Washington. All are welcome. OHSU welcomes people of all ages, ethnicities, genders, national origins, religions and sexual orientations. We are striving to build an anti-racist, multicultural institution and encourage people with diverse backgrounds to apply. To request reasonable accommodation, contact askhr@ohsu.edu
