The OHSU Digestive Health Center offers patients an interdisciplinary team approach to the prevention, detection, and treatment of digestive disorders. Our teams blend clinical expertise with research advances to achieve the best possible care and outcomes. The team includes patients, their referring physicians, and a wide range of OHSU specialists.
This position also comes with great benefits! Some highlights include:
The PAS Resource Specialist is responsible for handling all aspects of the surgery and clinic scheduling and managed care for the Digestive Health Center (DHC) General Surgery practice as it relates to new consult, surgery, and pre-op/post op scheduling processes for all patients’ surgical procedures using the electronic EMR (Epic) and the specific iQueue Program. This position participates in all training as required as it relates to surgical scheduling and managed care. This position will assist with DHC phone calls, clinic scheduling and other MCC duties as assigned. Position purpose also includes delivery of high level customer service to all internal and external customers. This position will assist with the ICD-10 /CPT coding for all surgical procedures. This position will also serve 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 referral reqirements per diagnosis and service.
1. Customer Service: 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, 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.
2. Managed Care Coordination: Maintains current information on managed care insurance plans and serve as a liaison and information resources for physicians, nursing support staff, co-workers, referring physician’s offices, patients and insurance companies on authorization requirements per diagnosis and service. Gather and/or verify patient information including demographics, insurance coverage, and financial status in accordance with OHSU and OHSUMG best practices. Confirm patient eligibility for health care coverage and clarify any managed care arrangements. Initiates authorization requests for subsequent care. Enter all information accurately into OHSU databases and /or into the medical record when necessary. Document managed care in system accordance with OHSU and OHSUMG best practices. Serve as expert on ICD10/CPT coding requirements and issues. Obtain authorizations for clinical care, procedures, and all ancillary studies. Apply problem solving and negotiating skills in resolving patient concerns and managed care related problems. Follow up on pending authorizations until they are obtained.
3. Surgery Scheduling: Surgery and procedure scheduling for 2-3 high volume surgical providers; Schedule all surgical procedures for assigned physicians in accordance with OHSU best practices. Manage schedule between 3 locations- South OR, North OR, and CHH OR (36 OR rooms) on any given day. Utilize software to relay accurate scheduling information, including Cadence, EARL, and iQueue. Work directly with physicians on scheduling determining date availability and coordination of cases; Apply problem solving and negotiating skills in resolving patient concerns, managed care related problems and procedure scheduling issues. Serve as a liaison to OR for scheduling issues. Return phone messages. Attend Surgery Scheduling meetings to maintain current on best practices. Ensure that patients, families, physicians, hospital and all other related entites are fully informed of the scheduled procedures and assoiciated arrangements. Provide financial information for patients including pre-pays, co pays, deductibles and price packages; Check-in and check-out patients; Responsible for knowledge of, and correct handling of, cash collections for co pays and deposits; Documentation completed per OHSU cash handling protocol; Proper use of OHSU forms and documentation required for all patients; Follow department specific policy on cancellations and reschedules including proper documentation in the EMR; Maintain on a daily basis the department specific scheduling document (MS Word); Record out of office notifications on the departmental schedules.
4. Clinic Scheduling: Coordinate patient care appointments and managed care as directed by physician and/or nurse staff; Serves as a liaison and information resource for physicians, and nursing support staff; Return phone messages; Prepare and mail new 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 OHSU databases and /or into the medical record when necessary; Check-in and check-out patients; Proper use of OHSU forms and documentation required for all patients. Back up referral processing when referral coordinator and/lead worker needs assistance.
5. Call Processing: Responsible for connecting the patient with the appropriate individual to progress their care in the clinic; Transfers calls to schedulers as needed, creates telephone encounters, contacts nursing coordinators, and pages providers and staff as needed per circumstance; Scheduling and managing of patient access to Digestive Health Center (DHC); Create telephone calls from patients in the EMR which will include accurate documentation of requests for medication refills, complaints, general informatin inquiries and urgent health care concerns; Triage calls to the appropriate staff for patient care /needs assessment; Process call (answering, screening, routing, paging etc.) in a timely, polite, professional manner; Route calls to appropriate conclusion; 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 (ie refill, telephone, documentation, etc)
6. Integrated Care: Obtain prior medical records and studies when appropriate; Responsible for obtaining, recording, tracking, and verifying referrals and authorizations for the respective surgeries, clinic and lab when necessary; other duties as assigned.
7. Continued Professional 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.
One year of experience in a medical office setting, including high-volume direct patient contact, scheduling of appointments and obtaining managed care authorizations.
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
Demonstrated problem solving and negotiation skills in resolving patient concerns, scheduling challenges and managed care related problems.
Demonstrated understanding of managed care.
Demonstrated reliable attendance record.
Bachelors level degree.
Medical terminology preferred.
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