Department Overview

In this position, you will perform managed care tasks related to patient appointments, surgeries, and surgery scheduling tasks supporting multiple divisions within the Otolaryngology Department. Specifically, managed care tasks include checking benefits, requesting and obtaining authorizations for appointments, surgeries, and imaging, advocating insurance companies on the patient's behalf, working with providers to compile appeal documents, and ensuring that insurance companies have all needed information to process our requests, updating information in EPIC and notifying patients of possible out of pockets costs related to appointments and surgeries. You must maintain current information on all managed care insurance plan changes to utilize the information efficiently and effectively to obtain authorizations.

Surgery scheduling duties are highly patient-centric and involve completing all tasks associated with booking the procedure, providing detailed patient education, and coordinating care with all necessary parties. These steps ensure the patient is prepared, cleared, and can complete the surgery successfully. Provides backup clinic scheduling & front desk support to all divisions when needed. This position requires applying problem-solving skills to resolve complex scheduling situations using negotiating skills and available resources to ensure that the task are completed in the best interest of the patient and the department. Strong critical-thinking skills are required to determine how to schedule to best optimize the providers time and available operating block.

 Functions as an integral department member by contributing to new ideas for improving customerservice and reducing costs. This position is expected to apply problem-solving and negotiating skills in resolving provider, patient, and insurance concerns. In addition, this position is expected to work independently and be an effective team member. Serves as a liaison and information resource for physicians, nursing support staff, coworkers, IP admitting, perioperative services, and patients. Assist in other miscellaneous administrative tasks as needed within the Otolaryngology Department.

Function/Duties of Position

Managed 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 ICD9 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. Applies problem solving and negotiating skills in resolving patient concerns and managed care related problems.

Surgery Scheduler:

• Maintains current information regarding surgery schedules for service site providers. Serves as liaison and information resource for physicians, nursing support staff, coworkers, IP Admitting Department, Surgery Office, and Periop Services. Collects from physician all information necessary to schedule a surgery (including ICD9 codes, equipment needs, etc.). Maintains surgery information to OR as soon as received. Starts insurance process and obtains authorizations. Facilitates care arrangements by scheduling preops, PAT clinic, ancillary and clinical services as needed. Applies problem solving and negotiating skills in resolving provider and patient concerns and other surgery related problems.

Telecommunications:

• Triages and documents accurately telephone calls from patients including requests for medication refills, complaints, general information inquiries, and urgent health care concerns. Delivers such information or requests promptly to the appropriate providers or their designees.

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 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.

Job Related Knowledge, Skills and Abilities:

• Basic computer skills, background working with Microsoft Word, Outlook, Excel, other windows applications, on-line scheduling, and databases.
• Working knowledge of medical terminology.
• Strong relationship building skills with patients, care plans, providers, clinic staff, management, OHSU and community partners.
• Exceptional customer service skills - both in-person and on the telephone.
• Exceptional interpersonal skills-able to resolve conflicts and problem solve between parties.
• Demonstrates active listening skills and supportive, professional behavior.
• Demonstrated evidence of excellent written and verbal communication skills.
• Demonstrated effectiveness in confrontation customer interactions.
• Ability to manage multiple priorities, prioritize workload, meet deadlines and meet urgent patient, physician and system needs.
• Ability to work accurately without close supervision.

Preferred Qualifications

Education:

• BS or BA

Experience:

• One year experience in a medical office setting working with diagnosis and procedure codes
• One year experience working with insurance benefits and authorizations.

Job Related Knowledge, Skills and Abilities:

• Proficient in university network computer applications using Windows, and EPIC system.

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.