We are seeking a Patient Access Services Resource Specialist to support the Child and Adolescent Psychiatry Outpatient Clinic within the Department of Psychiatry. The CAP Clinic is located on the seventh floor of Doernbecher Children's Hospital and provides care and consultation for the full range of childhood mental health disorders. This position performs all routine managed care responsibilities to secure referral and/or authorizations for all scheduled appointments. This includes gathering appropriate and correct patient demographics, financial information, confirming health coverage including managed care arrangements, financial screening, workers compensation status, and non-covered service status. This position is responsible for informing patients about billing mechanisms and is an insurance and coding resource for clinics and administrative staff. This position clearly documents all interactions with referring sources, insurance companies and billing colleagues.
This position provides back-up support for PAS staff. We are seeking someone who works well in teams and can communicate and collaborate effectively.
Managed Care Coordination:
This position is responsible for verifying insurance eligibility and securing referral/authorization prior to outpatient appointment. The authorization process includes, but is not limited to, entering referral information in Epic, tracking visits used per authorization, maintaining current information on all managed care insurance plans, verifying patient information, confirming patient eligibility, and following up on pending authorizations until they are obtained. Documents all information clearly. Works well with team of Management, PAS and PASR personnel within the Department to work through any authorization difficulties.
This position serves as a role model on best practices with the DAR. Monitors the Daily Activity Report (DAR) for the clinics and communicates business and clinical directives to PAS Specialist on daily basis. Keeps DAR updated ahead of schedule regularly. Makes sure all appropriate appointments are scheduled on the Psychiatry accounts. Shares PAS expertise and disseminates PAS information. Instructs co-workers in user skills for PAS system software. Instructs co-workers on computer and business skills as needed for Epic, and University Medical Group (UMG).
Monitors clinic billing and reports to manager. Maintains PAS Specialist skills in the areas of enrollment and authorization, arranged care, point of service operations, integrated care and telecommunications. Required to fill in for PAS Specialists as needed.
Provides high quality customer service to external customers (clients, insurance carriers, referring providers, etc.) and internal customers (OHSU providers, staff and University Medical Group) that meets or exceeds service standards. Duties include greeting patients with prompt and professional communication, face-to face and phone customer contact skills, crisis management and triage, facilitating with available information, technology, complaint process, flexible coverage of internal service needs and the continuous application of process improvement method and skills. This position will be trained in suicide prevention best practices and will assist if customers present who are suicidal.
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.
Charge Entry/Charge Review Work Queues (WQ):
Reviews and resolves any denials or other billing disputes. Works directly with Practice Manager/UMG Client Service Analyst to resolve and work through back-end billing issues.
Liaison and Staff Resource:
Services are liaison and information source for other department support staff, physicians, and patients, including face-to-face patient service. Uses knowledge of psychiatric diagnoses, procedures, and billing codes to communicate insurance issues with patients, providers, and staff.
Provides back-up support for PAS staff as needed. Serves as coverage for breaks and lunches, works as part of an integrated team to optimize all aspects of the clinic operations. Provides other duties as appropriate.