The PAS Resource Specialist is responsible for assuring that appointments and ordered services will be covered by the patient¿s insurance, or if uninsured, the PAS Resource Specialist assist pt in finding funding and fills out applications for assistance and necessary support. The PAS Resource Specialist provides managed care services for the work unit by providing excellent customer service through prompt and professional communication skills, occasional face-to-face customer contact skills, and excellent problem solving skills. The PAS Resource Specialist also works with patients to help them to understand their insurance benefits and payment obligations. The PAS Resource Specialist works directly with OHSU providers, outside ordering providers and facilities, clinical, and office staff to obtain information, carry out, and coordinates a wide variety of advanced technical, administrative, and clinical related tasks. The PAS Resource Specialist works as a facilitator and liaison for the various OHSU community collaborators in ensure community patients receive quality care in a timely fashion. PAS Resource Specialist work with community providers to obtain authorizations and coordinate care for outside OSHU providers and their patients, identifying and removing any obstacles or hurdles that are preventing timely care for patients.

Key Responsibilities & Performance Standards

• 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, infusions, 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. 
• Maintains current information on managed care insurance plans and serves as a liaison and information resources for physicians, nursing support staff, 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 ICD10 coding requirements office visits, and care arrangements by obtaining authorizations and contacting other ancillary and clinical services as needed. Applies problem solving and negotiating skills in resolving patient concerns and managed care related problems.
• Reviews orders and documents treatment approvals and locations in patient’s record (EMR).  Monitors all treatment regimens for insurance coverage and appropriateness of indication and follows up with Ordering providers should any further or additional information, I.E. letter of medical necessity, be needed in order to ensure claims are paid by insurance
• Arranges and orders associated clinical, diagnostic, or laboratory services; obtains authorizations when necessary as well as If pt is uninsured/ underinsured, assist pt in finding foundational assistance to cover desired services.  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, and when necessary; initiates authorization requests for subsequent care.
• Functions as a “point of inquiry” and resource for all work unit staff with questions regarding insurance coverage and where scans and treatments may be done.
• Applies problem solving and negotiating skills in working with insurance companies and referring providers to obtain a successful outcome.
• Performs financial counseling with patients prior to treatment and calculates co-insurance amounts as requested or obtains costs of treatment for ABN preparation.
• Reviews additions to the schedule of same day and next day appointments from outside OHSU providers for insurance and authorizations of medications to infuse in the day treatment clinic.
• If pt is uninsured/ underinsured, assist pt in finding foundational assistance. Performs research and processes paperwork for financial assistance from foundations and drug manufactures to help patients pay for specialty drugs or services with high copay or co insurance amounts.
•  Assists the employment supervisor with interviewing and hiring PAS Resource Specialist, Orients new employees and makes arrangements for training. Monitors for timely completion of training requirements and demonstration of core competencies

• 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.

• Associate Degree or higher;  minimally some college coursework in related field
• Experience in working with chemotherapy drugs in medical oncology setting
• Knowledge of computer applications including Epic Cadence, and EARL

 

This position works in a busy office environment with multiple, competing demands; frequent interruptions, and interpersonal interactions with both internal and external customers.  Hours:  8:30 am - 5:00 pm, M-F. Position requires employee to travel occasionally between the various offices of the OHSU Community Oncology work unit.

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.