The PAS Resource Specialist is the initial point of contact for OHSU patients. They are the face and voice of the OHSU Comprehensive Pain Center. The incumbent must be motivated to create the ideal patient and family experience. This position supports the OHSU Comprehensive Pain Center operations with overall new patient schedule coordination for patients and providers. The position works with patients, families, providers, clinical and non-clinical staff to coordinator the patient’s experience throughout the process of accessing healthcare at OHSU.

 

The PAS Resource Specialist is responsible for managed care coordination, enrollment and authorizations, patient referrals, customer services and scheduling patients. Additionally, the position provides leadership and guidance for PAS Specialists in the areas of financial screening, patient eligibility for services, managed care and other health care contract terms.

Managed Care Coordination and Patient referrals:

• Process all referral work queues for the scheduling of consultations, procedures while assessing the patient’s needs based on diagnosis, insurance coverage and medical records.
• 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.
• Works closely with managed care team to coordinate authorization 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.
• 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.
• Make updates via Epic when necessary.
• Accurately create new medical records for a new OHSU patient if they are not currently in Epic. Create an Epic referral for processing as well as to document insurance information per standard work expectations. Document any subsequent interactions with insurance company or others involved in the process of processing new patient referral.
• Clearly and thoroughly document any and all actions taken on a referral based situation following all OHSU Ambulatory standard work  protocols
• Based on financial status of patient and if they are insured, determine if they are eligible to have an appointment scheduled or if they first need to go through financial screening.

Customer Service and Scheduling

• Greets patients and confirms appointments. Inspects insurance cards and/or authorization notices. Identifies and collects deductible payments, co-payments, and deposits on services; provides receipts and completes necessary accounting procedures including reconciliation and deposit of funds. Explains and satisfies any necessary patient signature requirements. Validates parking.
• Provides 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, facility with available information, technology, standard complaint processing, flexible coverage of internal service needs, and the continuous application of process improvement methods and skills.
• Schedules new patient appointments on line, and manually if necessary. Obtains prior medical records and studies if appropriate.
• Arranges stretchers, wheelchairs, and interpreters when necessary, and accommodates other special needs whenever possible. Mails information packets. Provides personal reminders to patients about upcoming appointments. Obtains and prepares OHSU medical records before scheduled appointments. 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.
• Receive incoming phone calls via the Automated Call Distributor (ACD).
• Creates and sends new patient packets for scheduled appointments
• Escalate all concerns or complaints to manager or supervisor, utilizing established chain of command
• Demonstrate courteous and professional behavior when dealing with patients/staff at all times
• Monitor daily outlook inbox’s if you’re assigned as a daily task; Monitor personal outlook email communications daily; Monitor personal Epic Inbasket daily
• Uses the wait list to ensure provider appointment slots are full daily for consultations, office visits and procedures
• Consistently answer telephones in a timely manner and within defined standards
• Triage phone calls and transfer to appropriate practice using the defined standards
• Proactively perform outbound call work: this includes but not limited to calling patients to inform them a referral has been received in our system. Process & schedule using departmental resources & tools while following standard work. Calling patients to explain insurance authorization complications for scheduled appointments
• Manages a positive patient expeience at all times
• This position is a key contributor to patient satisfaction initiatives with the OHSU Ambulatory clinics. This position has a direct effect on patient experience metrics re: access and appointment scheduling.
• Resolve patient inquiries or escalate to higher levels for solution
• Escalate all complaints to manager or supervisor, utilizing established chain of command
• Demonstrate courteous and professional behavior when dealing with patients/staff at all times
• Manages a positive patient experience at all times

Compliance and Other:

• All responsibilities are to be carried out in an ethical and professional manner. This position/employee should report potential compliance problems using the reporting processes as outlined in the Code of Conduct manual.  This position/employee should be a model of ethical and appropriate behavior for other departmental personnel and should exhibit professional standards, comply with OHSU policy and procedures and maintain personal integrity at all times.  
• Participation in compliance and procedural training programs is expected.  It is expected that this position/employee comply with the Code of Conduct, OHSU and departmental policies & procedures, applicable rules, regulations, etc.
• It is expected that OHSU computer systems (such as Outlook and the Internet) will be used only for departmentally approved functions.  No personal use of OHSU computer systems during paid work hours is acceptable.
• The position is also involved in recognizing and reporting access barriers to their immediate supervisor.
• Other duties as assigned

Customer Service:

• At all times must exemplify high quality customer service to both external customers as well as internal customers that meets or exceeds the service standards as set by OHSU.
• This duty includes prompt and professional communication efforts, high-level conflict resolution, flexible coverage of internal service needs, continuous application of process improvement methods and skills, crisis management, & developing a standard complaint process for process improvement.

Experience:

• 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 OR
• One and a half years of work experience on 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 (Competencies):

• Basic computer skills including word processing.
• Windows applications
• on-line scheduling, and a preference for data-base skills.
• Excellent verbal and written communications skills.
• Strong customer service orientation.
• Demonstrated effectiveness in confrontational customer interactions.

Education:

• High School Diploma or GED; OR
• AA degree or some college coursework.

Experience:

• 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.

Job Related Knowledge, Skills and Abilities (Competencies):

• A thorough knowledge of patient and referral processes in EPIC
• Advanced patient scheduling skills
• Prior experience with surgery scheduling
• Experience with electronic scheduling, and electronic medical record systems
• Intermediate knowledge and skills in Excel

Must be able to share office space with collegues and physicians. Incumbent must be able to multi-task in a high-volume high noise level environment with multiple demands and interuptions. 

Must be able to sit long periods of time, as well as spend 90% of time on telephone and computer usage.

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.


As an organization devoted to the health and well-being of people in Oregon and beyond, OHSU requires its employees to be fully vaccinated against COVID-19.