This position is responsible for the direct supervision of the centralized managed care activities within the Centralized Managed Care (CMC) Department. Managed care activities include eligibility and benefit verification, preauthorization and patient estimates for all departments that are supported by the central team. This position directly supervises 18-23 staff and has the responsibility for the following:

 

• Eligibility verification
• Preauthorization (for all services including office visits, infusion services, inpatient admissions, chemotherapy, pharmacy medications)
• Benefit level exceptions as applicable
• Patient liability estimates
• Retroactive authorizations and appeals for denied services

The Supervisor leads their team by recruiting, training, mentoring, and managing the work queues and performance of their direct reports, to ensure the department's key performance indicators are met. The supervisor will also perform the duties of their staff as needed. In addition, they will serve as the first line of communication with the practices/departments to answer questions, trouble shoot issues and improve processes/workflows. This position reports to the Centralized Managed Care and Price Estimates Manager.

Eligibility Verification, Pre-Authorization

• Ensures that each high liability patient contact has a valid Epic referral attached to the appointment.
• Ensures any services requiring pre-authorization are requested within established timeframes.  Re-prioritizes resources when necessary to ensure metrics are met.
• Ensures all eligibility verification and pre-authorization information is documented accurately in the Epic referral.
• Reviews denials for lack of pre-authorization to attempt to resolve the issue.  Recommends changes to processes to improve denial rates.

Staff Development

• Ensures that each employee demonstrates competencies in the workflows they are responsible for.
• Provides cross training opportunities to promote growth and team flexibility.
• Manages lead workers and ensures they receive training and development opportunities to manage their workloads more effectively.

Department / Practice Communication and Management

• Serves as the first line of communication with the practices/departments to answer questions and trouble shoot issues.

Quality Improvement

• Performs quality assurance audits for employees. 
• Establishes goals for employees with the help of the manager.
• Uses audits to improve staff education.
• Conducts regular “in-service” trainings for staff based on audits.
• Works with other Supervisors to ensure staff are held to the same standards.
• Utilizes feedback from audits, practices/departments, and staff to design, create, and revise workflows to gain efficiencies and minimize financial risk with the support of the manager.

Daily Huddles / Visual Boards

• Performs daily huddles with staff to ensure they have what they need for the day, are aware of priorities and allows staff to surface issues.
• Creates and maintains visual boards that demonstrate the performance of the team.
• Rewards staff for meeting performance standards and uses boards to assist in process improvement.
• Participates in Ambulatory OPEx initiatives as necessary. Uses lean tools to continuously improve.

Patient Liability Estimation

• Works with staff to provide patients with estimates of their potential cost of care using the Epic estimate tool. 

Other duties as assigned.

• Associates degree in related field or combination of education and equivalent experience.
• Three years of prior experience in a clinical setting working with patient scheduling, benefit verification, pre-authorization, and a high level of patient interaction.
  • Experience should demonstrate progressive additions to responsibility and time spent serving as a lead worker.
• Healthcare revenue cycle experience. 
• Must be familiar with Microsoft Office products. 
• Must have superb organizational skills and strong customer service orientation and experience. 
• Must have ability to work autonomously, be flexible and able to shift priorities on short notice.
• The ideal candidate is driven by achieving outcomes in a timely manner. 
• A working knowledge of OHSU system, policies, procedures and the OHSUMG practices is a must.

• Bachelor’s Degree. 
• Coursework in Healthcare and/or Education. 
• Specific experience with an integrated health record, Epic preferred.
• Experience with determining acuity of patient for managed care purposes.
• A working knowledge of OHSU systems, policies, procedures and the OHSUMG practices. 
• Experience with supervising staff who perform managed care, scheduling, and patient estimation.

Although the position is expected to work standard Monday – Friday business hours, there will be times when availability is necessary on weekends and during the evening.

Work Location: Remote and Downtown Portland (Fifth Avenue Building). Occasionally will include travel to off-site locations for meetings.

 

Benefits

• Healthcare for full-time employees covered 100% and 88% for dependents.

• $50K of term life insurance provided at no cost to the employee.

• Two separate above market pension plans to choose from.

• Paid time off - 208 hours per year, prorated for part-time.

• Extended illness bank - 64 hours per year, prorated for part-time.

• 9 paid holidays per year.

• Substantial Tri-Met and C-Tran discounts.

• Employee Assistance Program.

• Childcare service discounts.

• Tuition reimbursement.

• Employee discounts to local and major businesses.

We are Oregon's only public academic health center.

In addition to caring for patients, we lead groundbreaking research. We also train the next generation of health care professionals. As Portland's largest employer, we give you opportunities to learn and advance in a system of hospitals and clinics across Oregon and Southwest Washington.

All are welcome.

OHSU welcomes people of all ages, ethnicities, genders, national origins, religions and sexual orientations. We are striving to build an anti-racist, multicultural institution and encourage people with diverse backgrounds to apply.

To request reasonable accommodation, contact askhr@ohsu.edu