This position supports a range of administrative and clinical support functions for the Spine Center. The PAS Resource Specialist is responsible for work in the areas of financial screening, patient eligibility for services, managed care and other health care contract terms, billing and coding, and complex patient referrals. The PAS Resource Specialist gathers and records required information about patients; provides specific customer services which include screening for financial eligibility, confirming health insurance coverage and individuals' obligations, obtaining necessary authorizations for care, coordinating medical, surgical, and diagnostic test appointments, and assisting patients in an office and clinic setting. 

 

Duties include processing pre-authorization requirements with outside entities, handling incoming calls, processing new patient referrals, return visit requests, provider inquiries, as well as reviewing outpatient instructions with the patient and triaging phone calls related to patient care. This position may also provide instruction to PAS-S personnel on processes and procedures and will provide cross-coverage and fill-in coverage as needed for department PAS-S and PAS-R roles, as directed by the supervisory team.

 

• 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.
• Arranged Care. Coordinate high volume of complicated patient care appointments, procedures, and infusion treatments as directed by physician and/or nurse staff; Uses EMR and other systems as needed for scheduling. Creates a medical record if needed. Provides personal reminders to patients about upcoming appointments. Serves as a liaison and information resource for physicians, and nursing support staff; Return patients messages (phone and/or electronic); Prepare and mail patient information packets; Direct patients to appropriate providers for other health care issues; Complete and route direct referrals to other clinical services; Enter patient information accurately into the electronic medical record when necessary.  Maintains a service-based working knowledge of oncology practice. Obtains prior medical records and studies if appropriate. Arranges for wheelchairs, interpreters, or other assistive devices as necessary to support safe, high-quality care. Other duties as assigned.
• Customer Service / Point of Service Operations. Provide the highest level of customer service to both external customers (patients and their families, referring providers, insurance carriers, etc.) and internal customers (OHSU health care providers and staff) that meet or exceed the service standards of the health care industry. This duty includes prompt and professional communication efforts, exemplary phone etiquette, face-to-face customer contact skills, high emotional intelligence including during stressful situations, utilization of available information technology, consistently following standard work, flexible coverage of internal service needs and the continuous application of process improvement methods and skills. Greets patients and, where appropriate, checks them in prior to being seen by clinical staff.  Gathers and/or verifies patient information including demographics, insurance coverage, and financial status.  Checks patient account numbers and corrects any problems, seeking advice from Central Registration as required. Ensures that all appointment comment information is accurate and complete.  Enters all information accurately into OHSU databases or into the medical record when necessary.  Inspects insurance cards and/or authorization notices. Explains and satisfies any necessary patient signature requirements (including non-covered service forms). Identifies and collects co-payments, provides receipts, and completes necessary accounting procedures as needed. Notifies clinical staff when patients arrive, monitors the length of patient wait times and intervene as necessary. Distributes medication lists to patients and prepares other duties associated to clinic as needed. Validates parking as needed.
• Integrated Care. Schedules associated clinical, diagnostic, or laboratory services; obtains authorizations when necessary. Contacts primary care physicians or their designees to obtain authorizations for care when needed. Scheduling activity may occur as part of check out processing, or separately. Directs patients to appropriate providers for other health care issues. Completes and routes direct referrals to other clinical services. Directs patient questions regarding billing and insurance payments to appropriate staff.
• Telecommunications. Takes incoming/inbound calls and/or makes outgoing/outbound calls from/to patients, referring providers, or other stakeholders; Connects callers with the appropriate individual(s) to address their questions and/or progress their care; Create EMR telephone encounters that include accurate documentation of requests, such as medication refills, complaints, general inquiries or urgent health care concerns; Direct calls/messages to the appropriate staff for patient care /needs assessment; Process calls (answering, screening, routing, paging etc.) in a timely, polite, professional  manner; Delivers information or requests promptly to the appropriate providers or their designees. Transfer calls as needed and engage nursing, physician, APP, or other care team personnel per circumstance; Provide information to callers, including directions, addresses and hours of operation; Use schedules and departmental procedures to locate appropriate on-call person for internal and external callers; Understand and process calls per departmental policy for each encounter type (i.e. refill, telephone, documentation, etc.)
• PROFESSIONAL RESOURCE & DEVELOPMENT: Participate in appropriate educational activities that enhance general knowledge or ability to do assigned work; Attend staff meetings and other informational sessions; Read vendor documentation, trade publications, or other appropriate publications; Interact with peers and other employees to receive and disseminate information; Attend and particiapte in department huddles as appropriate; Trains and orients new staff; Cross-trains for positions in assigned or other areas; Identifies process improvement opportunities, communicates opportunities to direct supervisor, and helps create or enhance standard work; Participates in ongoing professional development and competency assessment; Communicates additional training needs to direct supervisor. Carries out job responsibilities in an ethical, effective and professional manner.  Reports potential compliance problems using the reporting processes as outlined in the Code of Conduct.  Models ethical appropriate behavior, professional standards, compliance and personal integrity. Understands and complies with the Code of Conduct, OHSU and department policies and procedures, applicable rules, regulations, etc.  Carries equal share of workload, demonstatrate the ability to multi-task and provides on-going operations support. Performs other duties as assigned by supervisor/manager.
• 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 ICD9 coding 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

• • 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.

• Clinic operating hours. Occasional extended hours, to include but not limited to, evenings, weekends, and/or holidays may be occasionally required. Employee must have vehicle in order to travel between sites within the Community Hematology Oncology Unit.
• Stooping, Crouching, Reaching, Listening, Sitting, Keyboarding, and ability to lift up to 50 lbs

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.