Clinical Genetic services are a complex medical specialty with unique patient care and faculty support needs.  The Molecular and Medical Genetics PAS Resource specialist is responsible for supporting referral processing, patient scheduling and managed care within the medical genetics practice.   This position will support ambulatory clinics including but not limited to return patient scheduling, patient letters, medical record requests, scanning and other clerical support. The delivery of high-quality customer service to all internal and external customers with a patient centered approach is expected.   The position involves patient contact over the phone, coordinating care with referring providers and obtaining insurance authorizations for office visits/consultations.  The position will also support insurance authorization needs for medication, infusion and other services for our Metabolic Genetics Clinics. This role will serve as the first point of contact for patients as well as referring providers and strong communication and customer service skills are essential.  A thorough understanding of epic functions, strong problem solving and the ability to communicate effectively with multi-disciplinary healthcare teams is required. Our team is focused on standardized and efficient process flow within a continuously improving clinical environment.  Out team members should demonstrate an awareness of and responsiveness to the medical genetics system of healthcare and the ability to effectively call on system resources to support care that is of optimal value.

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:

• Schedules new patient appointments. Obtains prior medical records and studies as directed by the clinical staff and Providers. Prior to patient scheduled appointment, obtains lab reports, procedure documents, CDs, on-line communications, OHSU medical records, and other medical reports from referring physicians as required by various clinical genetics subspecialties. Accommodates patient special needs such as: wheelchairs, stretchers and interpreters. Mails information packets and provides patients with pre-clinic visit information and reminders.

Customer Service:

• Provides high quality customer service to both external customers (patient, referring providers, and insurance carriers) and internal customers (OHSU health care providers and staff) that meets or exceeds 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.  

Integrated Care:

• Arranges and orders associated clinical, diagnostic, or laboratory services; obtains authorizations when necessary. Directs patients to appropriate providers for various health care issues. Completes and routes direct referrals to other clinical services. Contacts PCP or their designees to obtain authorizations for urgent care. Schedules return appointments. Initiates authorizations requests for subsequent care.

Telecommunications:

• Triages and documents accurately telephone calls from patients including requests for medication refills, complaints, general information inquiries, and urgent health care concerns.  Delivers such information or requests promptly to the appropriate providers or their designees.

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.

Training and Competency:

• Successfully completes the required PAS initial training and core competency assessment before or during the trial service period.  Completes all required update modules.  Maintain core competencies, and demonstrate continuous application of these skills throughout the period of employment. Support and assist in the development of continuous quality improvement components of the clinical practice.  Build upon the OHSU Performance Excellence System (OPEX) to continuously improve Clinical Genetic Service.

Clinical Service Resource:

• Shares PAS expertise and disseminates PAS information to PAS Specialiests wihtin the service area.  Instructs co-workers as needed in user skills for PAS system software including RSS, Order Entry, LCR, EAD and the minimal and common data sets.  Maintaines a service based working knowledge of diagnositic and procedural coding.  Fills in as needed for any PAS or PASR position within the service areas.

 

• 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 Degree or GED; OR Associate Degree or Bachelor’s Degree in Healthcare Administration or Business
• 2 year PAS experience at OHSU with experience answering busy incoming phone lines
• Managed care insurance authorization training
• Proof of passing the OHSU PAS training

• Sitting for 8-10 hours per day at desk performing tasks on a computer.
• Understanding ergonomic needs associated with long-term setting and computer-screen eye strain.

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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