This position is an integral part of the Division of Cardiothoracic Surgery. This position directly supports the department objectives of Clinical Care, Quality Assurance, Education and Research. This position is responsible for access management of new and returning patients; perform all managed care duties to ensure successful reimbursement for services; schedule patients for clinical and surgical appointments; provide front desk services in the clinical setting; provide PAS expertise and training to co-workers; provide all of the above to the highest level of customer service excellence standards.

Customer Service: Provides high quality customer service to both external customers (patients and their families, 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.

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.

 

Arranged Care: Schedules new patient appointments online, and manually if necessary. Obtains prior medical records and studies if appropriate. Creates a medical record if needed. Arrange stretchers, wheelchairs, and interpreters when necessary, and accommodate 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. 

 

Integrated Care: Arranges and orders associated clinical, diagnostic, or laboratory services; obtains authorizations when necessary. Directs patients to appropriate providers for other health care issues. Completes and routes direct referrals to other clinical services. Contacts primary care physicians or their designees to obtain authorizations for urgent care. Schedules return appointments on line, and manually if necessary; initiates authorization requests for subsequent care. 

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 ICD9coding 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. 

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.

 

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. Triages and routes or completes incoming faxes to appropriate providers or their designees. 

 

Point of Service Operations: Greets patients and confirms that an appointment has been kept. Inspects insurance cards and/or authorization notices. Identifies and collects deductible payments, co-payments, and deposits for services; provides receipts and completes necessary accounting procedures including reconciliation and deposit of funds. Verifies and updates the common data set on-line. Explains and satisfies any necessary patient signature requirements. Validates parking.

 

Clinical Service Resource: Shares PAS expertise and disseminates PAS information to PAS Specialists within the service area. Instructs co-workers as needed in user skills for PAS system software including RSS, Order Entry, LCR,EAD, and the Minimal and Common data sets. Maintains a service-based working knowledge of diagnostic and procedural coding. Fills in as needed for any subordinate PAS position within the service areas.

 

Personnel Operations: Gives instruction for other PAS personnel pertaining to PAS processes and procedures as well as performance. Provides on the job training, orientation, guidance and coaching for new PAS personnel in the service area. May be required to distribute PAS duties within a defined work-group and to review work for conformance to standards. May be required to provide informational assessment of other PAS workers’ performance to the PAS Coordinator/Supervisor and/or the employment supervisor. 

Training and Competency: Successfully completes the required PAS initial training and core competency assessment before or during the trial service period. Completes all required update modules. Maintain core competencies, and demonstrate continuous application of these skills throughout the period of employment.

• Proficient with managed care functions including eligibility issues, authorizations, referrals and TOS payments/collections.

• 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. 

• 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.

• HS Diploma or advanced degree preferred.
• Experience in a medical and/or surgical office setting.
• Knowledge of Epic, OHSU network systems, including Outlook and
• Microsoft Office products.
• Knowledge of iQueue.

Ability to work general business office hours from 8:30am to 5:00pm. May occasionally need to arrive early or stay late to accommodate clinic, patient, physician needs or workload needs.

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.