PAS Resource Specialist
Department Overview:
OHSU Casey Eye Institute is a premier academic medical center providing eye care for adults and children in the Pacific Northwest and beyond. We treat eye conditions from the most straightforward to the most complex and offer expert care in all ophthalmology specialties.
Since 1945, OHSU Casey Eye Institute doctors and vision scientists have worked side by side to discover the causes of eye disease and find new treatments. Bringing research and patient care together helps us turn possibilities into realities OHSU Casey Eye Institute is a "High Performing" eye hospital, which means we are ranked in the top 10 percent nationally by U.S. News & World Report.
The primary responsibility of this position is a managed care coordinator for the Pediatric Ophthalmology Division at Casey Eye Institute. This position provides an exceptional level of customer service to external and internal customers. This is a full time, benefitted, non-remote position.
Function/Duties of Position:
Managed Care Coordination. Serves as a resource for insurance and billing questions for patients, staff and referring physicians. 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.Strong knowledge of OHSU insurance contracts with medical and vision carriers and the ability to explain the billing differences to patients, staff and referring physicians. Answers insurance questions for all patients, scheduled or non-scheduled, directing patients to appropriate provider for other health care issues.
Obtains all authorizations, including retroactive authorizations, contacting primary care physicians or their designees to obtain authorizations for care as required. The authorization process includes, but is not limited to, putting the referrals information on-line, tracking the number of visits used per authorization, following up on referrals for return appointments and other miscellaneous tasks.
Gathers and/or verifies patient information including demographics, insurance coverage, and financial status, ensuring all information is current prior to patient appointment. Educates patients on related billing issues as appropriate; quoting self-pay or deposits where indicated and completing all clinic non-covered and patient estimate service forms for the front desk.
Notifies patients if appointment will be considered non-par per insurance guidelines. Obtains authorizations for clinical care, procedures, and laboratory studies. Enters all information accurately into OHSU databases (EARL) or into the medical record when necessary.
Follows up on pending authorizations until they are obtained. Works closely with Faculty and Fellow to ensure authorizations/referrals in place prior to any appointments, diagnostics or procedures involving managed care patients.
Arrange Care for patient appointments and MRI scheduling. Gather and/or 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 clinical care, procedures, and laboratory studies. Enter all information accurately into OHSU databases or into the medical record when necessary. Schedule new and return patient appointments on line. Obtain prior medical records and studies if appropriate, and assure information is in patient’s chart at time of visit.
Arrange stretchers, wheelchairs, and interpreters when necessary, and accommodate other special needs whenever possible. Confirm patient appointments, reminding patients of co-pays, and deposits or self-pay where indicated. Provide personal reminders to patients about upcoming appointments.
Triage phone calls, dispensing appropriately, including facilitation of prescription refills. Schedule new/return appointments, consults, walk-ins and emergencies. Prepare schedule for daily clinics. Other duties as assigned for back up.
Back up for new patient referral Workqueue and coordinates with Orthoptists and Faculty. Pulls referral data, demographics, reviews and prioritizes patients based on urgency. Works closely with Orthoptist lead and faculty to ensure new patients are properly triaged and scheduled.
Integrated Care. Arrange and order associated clinical, diagnostic, or laboratory services; obtain authorizations when necessary. Direct patients to appropriate providers for other health care issues. Complete and route direct referrals to other clinical services.Contact primary care physicians or their designees to obtain authorizations for urgent care. Schedule return appointments on line, initiate authorization requests for subsequent care.
Replace/cover for Receptionist at front desk as needed, checking patients in/out, making appointments, prepare charts, filing and other duties as assigned by manager.
Customer Service. Provide high quality customer service to both external customers (patient, referring providers, and insurance carriers) and internal customers (OHSU health care providers and staff) that meets or exceeds the service standards of the health care industry.This duty includes prompt and professional communication efforts, face-to-face customer contact skills, crisis management, and facilitate available information or requests promptly to the appropriate providers or their designees.
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 (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.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 keyboarding skills. Working knowledge of medical terminology. Strong relationship building skills with patients, health plans, providers, staff, management.Exceptional customer service skills
- both in person and on the phone.
- able to resolve conflicts and to problem solve between parties.
- evaluate patient concerns for timely resolution.
Sensitivity to patient needs.
Demonstrated evidence of strong written and verbal communication skills.Ability to manage competing priorities.
Ability to meet deadlines and urgent patient and system needs.
Ability to work independently; willingness to serve as a positive and professional role model.
Must have demonstrated record of reliable attendance, punctuality and proven successful performance in past and present.
Preferred Qualifications:
Ophthalmology experience or Pediatric Medicine experience strongly preferred.
Managed care experience strongly preferred.
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.