This position is responsible for managed care, insurance verification and patient price estimate processes within the Centralized Managed Care & Price Estimates (CMC) department. This position supports the OHSU systems and operations of ambulatory practices, professional services and hospital departments. This position works closely with internal and external customers including Intake Coordinators, Clinical Staff, Surgery Schedulers, Care Managers, Financial Counselors, Insurance Companies, PCP Office Staff, and CMC Leadership to ensure patients receive optimal financial services related to their care.
The Managed Care Coordinator and Insurance Verification & Patient Estimates Specialist are an integral part of the CMC team by providing clear and accurate information regarding our patient’s financial obligations related to their visits, 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 provide estimates, offer pre-service payment opportunity and collecting pre-service payments for visits, treatments, procedures and/or hospital admissions. This position is also responsible for providing guidance for other staff in the areas of patient liabilities, health care contract terms, complex patient referrals, and other managed care issues.
The incumbent will have an extensive knowledge of Managed Care and Insurance Verification processes in the ambulatory and inpatient setting including but not limited to insurance eligibility, benefits verification and authorization requirements. This role is knowledgeable about the Epic system and current best practice referral and prior authorization workflows. The incumbent is able to provide support and backup to the Centralized Managed Care & Price Estimates Department as needed for cross-coverage for all managed care and insurance verification workflows.
Centralized Managed Care and Insurance Verification
Patient Liability Estimates
Job Related Knowledge, Skills and Abilities
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