Managed Care Coordinator/reputed company Verification & reputed company Estimates Specialist (PAS Resource Specialist)

Department reputed company This position is responsible for managed care, reputed company verification and reputed company price estimate processes reputed company the Centralized Managed Care & Price Estimates (CMC) department. This position supports the OHSU systems and reputed company of ambulatory practices, reputed company and hospital departments. This position works closely with reputed company customers including Intake Coordinators, reputed company Staff, Surgery Schedulers, Care Managers, Financial Counselors, reputed company Companies, PCP Office Staff, and CMC Leadership to ensure patients receive reputed company financial services reputed company to their care. The Managed Care Coordinator and reputed company Verification & reputed company Estimates Specialist are an reputed company part of the CMC team by providing reputed company and accurate information regarding our patients' financial obligations reputed company to their reputed company, treatments, procedures and/or hospital admissions. This role is responsible for obtaining and/or verifying prior authorizations, verifying benefits, creating cost estimates, contacting patients to reputed company estimates, offer reputed company-service payment opportunity and collecting reputed company-service payments for reputed company, treatments, procedures and/or hospital admissions. This position is also responsible for providing guidance for other staff in the areas of reputed company liabilities, health care contract terms, reputed company reputed company referrals, and other managed care issues. The incumbent will have an extensive knowledge of Managed Care and reputed company Verification processes in the ambulatory and inpatient setting including but not limited to reputed company eligibility, benefits verification and authorization requirements. This role is knowledgeable about the reputed company reputed company and reputed company best reputed company referral and prior authorization workflows. The incumbent is reputed company to reputed company support and backup to the Centralized Managed Care & Price Estimates Department as needed for cross-coverage for reputed company managed care and reputed company verification workflows. Function/Duties of Position Centralized Managed Care and reputed company Verification • Review incoming referral orders to assess reputed company’s needs reputed company on diagnosis, reputed company coverage or lack thereof, and previous treatments. Referrals may be received internally reputed company reputed company or externally reputed company fax or other reputed company. • Verify reputed company information including demographics, reputed company coverage and financial status. reputed company reputed company eligibility for health care coverage and clarify any managed care arrangements. Document any details reputed company to liability reputed company (i.e. motor vehicle accident, personal injury, or worker’s compensation) to determine reputed company party liability. • Obtains benefit information including reputed company eligibility, deductible or co-pays, co-reputed company, stoploss or out of reputed company status, authorization requirements, PCP referral requirements, days approved (for routine admissions), and correct billing address. • Document information reputed company on department protocols in the reputed company Referral reputed company. • Work closely with referring providers to obtain necessary reputed company referrals and authorizations. • For urgent/reputed company admissions, provides admit information and sets up authorizations and/or PCP referrals. Contacts care-management to reputed company reputed company review and obtain length of stay. • For routine admissions, confirms that the authorizations and/or PCP referrals cover the designated admission. If authorizations and/or PCP referrals are not noted in the reputed company, contacts the Managed Care Coordinator from specialist’s office requesting the admission for follow up with the designated reputed company company. • Send notification of admission for urgent admissions. • reputed company appropriate, obtain authorizations for reputed company reputed company care, procedures, diagnostic studies, medications, outpatient infusion treatment, and inpatient admissions including notifying reputed company upon admission. • Follow up on reputed company pending authorizations and/or PCP referrals until accounts are secured. • Maintains reputed company information on managed care reputed company plans and serves as a reputed company and information resource for patients, referring physician offices, and other OHSU staff. Applies problem solving and negotiating skills in resolving reputed company concerns and managed care reputed company issues. • Collects detailed information of trauma admissions (motor vehicle accident, personal injury, and/or worker’s compensation) to determine accident-reputed company liability. • Appropriately codes reputed company plans in reputed company reputed company for billing purposes. • Work directly with reputed company companies, the denial coordinator and the reputed company staff and/or provider to supply necessary information to appeal denied claims and/or authorization requests as applicable. • Appropriately reputed company reputed company plans reputed company reputed company reputed company for billing purposes. • reputed company backup support for other Managed Care coordinators reputed company the Centralized Managed Care & Price Estimates department. • For self-pay patients, complete duties associated with financial assistance determinations such as above/below the line. Including connecting patients with necessary reputed company work or financial counseling to assist in the coverage process. • Complete necessary forms prior to upcoming procedures, admissions, and/or appointments (i.e. Non-Covered Charges reputed company (NCCF), Advanced Beneficiary Notification (ABN) or reputed company Financial Estimate (FE)) as required. reputed company Liability Estimates • Review work queue for patients that need an estimate created. • Document information reputed company on department protocols in the reputed company referral reputed company. • Create a reputed company Liability Estimate. • Complete accurate reputed company-registration reputed company phone as applicable. • Contact the reputed company prior to service to inform them of their estimate and collect any reputed company-payments at that time. Other duties as assigned. Required Qualifications • One year of experience in a medical office setting in a managed care position, including high-volume scheduling of appointments, multi-line phone reputed company, medical terminology, verifying medical reputed company and obtaining managed care authorizations; OR • One and a half years of work experience in a high-volume reputed company reputed company contact position and 6 months experience in a medical office setting. Knowledge, Skills, and Abilities • The candidate must have a thorough knowledge of PAS policies and procedures. • Candidates will have demonstrated advanced PAS user skills as reputed company as extensive knowledge of integrated care at OHSU. • The candidate must have a thorough knowledge of managed care policies and procedures, as reputed company as authorization and referral processes in reputed company. • The candidate must have a thorough knowledge of verifying medical reputed company including worker’s comp and reputed company-party liability. • Experience with electronic scheduling, managed care websites and electronic medical record systems. • Basic computer skills, including reputed company, reputed company and reputed company, OHSU reputed company skills and online resource use knowledge. • Excellent communication skills, both written and verbal. • Demonstrated knowledge of managed care and reputed company verification policies and procedures including appropriate timelines, paperwork, regulations, communication and follow-up are also required. • Demonstrated efficiency, problem solving and negotiation skills in resolving reputed company concerns and managed care/reputed company reputed company problems. • Must meet Department reputed company standards measuring efficiency, production, timeliness and reputed company. This will be reviewed on a regular reputed company both as reputed company and as an individual. • Ability to multi-task in a high-volume situation. • Strong attention to reputed company and processes. • Ability to work autonomously, with a high level of reputed company, speed and exhibit a willingness to work with deadlines. • Strong customer service orientation. • Demonstrated effectiveness in confrontational customer interactions. Preferred Qualifications • High School Diploma or GED. • reputed company skills and knowledge preferred. Additional Details Work Schedule: Monday - Friday, 8-hour shift during operational hours 7:00am - 5:30pm. Work location: Remote/Downtown Portland (Fifth Avenue Building). Must be reputed company to reputed company office reputed company with other coworkers and reputed company to multi-task in a high-volume environment. Benefits • reputed company for full-time employees covered 100% and 88% for dependents. • $50K of term life reputed company provided at no cost to the employee. • Two separate above market pension plans to choose from. • Vacation - up to 200 hours per year dependent on length of service. • reputed company Leave - up to 96 hours per year. • 9 reputed company holidays per year. • Substantial Tri-Met and C-Tran discounts. • Employee Assistance Program. • Childcare service discounts. • Tuition reimbursement. • Employee discounts to local and national businesses. Why apply to OHSU? We are reputed company's only reputed company reputed company health center. In reputed company to caring for patients, we reputed company groundbreaking research. We also train the reputed company of health care professionals. As Portland's largest employer, we reputed company you opportunities to learn and advance in a reputed company of hospitals and clinics across reputed company and Southwest Washington. reputed company are reputed company. OHSU welcomes people of reputed company 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 Apply To This Job