Family Medicine at South Waterfront is a community-based clinic offering primary care and specialty services for all types of patients. We treat everyone--babies, children, adolescents, adults (including moms-to-be), and seniors. Our services include prenatal care (including deliveries), women's reproductive health, behavioral health care and counseling, transgender care, pediatric care, travel immunizations, podiatry and foot care clinics, sports medicine, Osteopathic Manipulative Treatment (OMT), Office Based Medication Assisted treatment (OBAT), acupuncture, minor procedures, and health maintenance with preventive care. Between 175 and 275 patients are seen daily by our 40 plus providers assisted by 60 plus staff members.

 

The Managed Care Coordinator (MCC) is responsible for handling all aspects of the authorization process. The MCC processes incoming and outgoing department referrals along with prior authorizations for diagnostic services. This will include gathering appropriate and correct patient demographics, financial information, chart notes and other supporting documentation, and confirming correct health coverage.

Key Responsibilities & Performance Standards

• Manages referral work queues and processes.  Is responsible for verifying patient eligibility and securing referral/authorization prior to the outpatient appointment.  The authorization process includes, but is not limited to, putting the referrals information on-line, following up on referrals for return appointments, and other miscellaneous tasks.  This task includes management of the referral process from start to finish meeting or exceeding the appropriate service standards. 
• Gathers and/or verifies patient information including demographics, insurance coverage, and financial status. Confirms patient eligibility for health care coverage. Obtains prior authorizations for clinical care, procedures and diagnostic studies as appropriate.  Enters all information accurately into Epic.  Follows up on pending authorizations until they are obtained. Updates referral work queue.
• Maintains current information on all managed care insurance plans and is up-to-date with all managed care insurance plan changes, utilizing information to efficiently and effectively obtain authorizations.
• Serves as a liaison and information source for other department support staff, department physicians and referring providers/offices, OHSU Health Plan Office, patients, and insurance companies for authorization requirements per diagnosis and service type.
• Serves as a liaison and information source for other department support staff, department physicians and referring providers/offices, OHSU Health Plan Office, patients, and insurance companies for authorization requirements per diagnosis and service type.
• Communicates with patients/families, other health care team members, in a time and cost efficient, courteous manner.  Demonstrates active listening skills and supportive, professional behavior at all times, to patients, families and staff. Documents all care given, observations, and patient response to care, accurately and legibly in English, in the medical record.
• Fills in as needed for any business position within the service areas. Maintains a service based working knowledge of diagnostic and procedural coding. 
• Back up for answering phones and scheduling appointments as necessary; additional coverage for front desk duties as needed.

• 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 (dependent on position description). 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.

Knowledge and Skills Required:

• 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.

• High school diploma or equivalent.
• 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.
• Previous EPIC experience

• Exposure to ill patients – flu, colds, viruses. Work schedule is Monday and Tuesday 7:00am – 5:30pm; Wednesday 7:30pm – 4:00pm at Family Medicine at Gabriel Park; Thursday 7:30am – 4:00pm; and Friday 7:30am – 11:30am.

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.