Department Overview:This PAS Resource Specialist position is responsible for accurately managing a large volume transplant patient population and providing support for Clinical Transplant services. This position requires significant attention to detail and accuracy, quality assurance, and multi-disciplinary team communication. Duties include scheduling and coordination of visits, diagnostics, infusions, and other outpatient services as required; obtain prior authorizations as needed; referral coordination for post-transplant transfer-in patients; professionally documenting in a patient’s electronic medical record; lab entry, and other outpatient services as required; professionally documenting in a patient’s electronic health record; screening program related phone calls (patients, referring physicians, OHSU Staff, and insurance carriers); management of work queues to meet OHSU metric standards; frequently communicating to the multidisciplinary team; and provides assistance to patients, functioning as the liaison for insurance plans, providers, and care team members. This position requires significant attention to detail, accuracy, and timeliness as many of the job functions are to meet regulatory requirements. This position is vital for the efficient operation of a complex work unit. Function/Duties of Position: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 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, while considering fiscal impact.
Applies problem solving and negotiating skills in resolving patient concerns and managed care related problems.

Arranged Care

Schedules new patient appointments. Obtains prior medical records and studies if appropriate. Creates medical records if needed.
Arranges stretchers, wheelchairs, and interpreters when necessary, and accommodates other special needs whenever possible.
Mails information packets. Provides personal reminders to patients about upcoming appointments. Obtains and prepares OHSU medical records before scheduled appointments.

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.

Referral Coordination

Maintain and track incoming post-transplant patient referrals. Process referral according to OHSU standards. Applies problem solving and negotiating skills in resolving patient concerns and referral related problems.

Other Duties as Assigned Required Qualifications:

One year of experience in a medical office setting, including high-volume direct patient contact, scheduling of appointments and experience obtaining managed care authorizations. 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.
Must be able to perform the essential functions of the position with or without accommodation

Preferred Qualifications:

Prefer BS or BA in any area.
Cardiology and/or organ transplant medical office experience.
Knowledge of OHSU system software including EPIC, Phoenix, and electronic eligibility systems
Medical protocol processing experience.
Laboratory data entry experience.
Advanced EMR management.
Advanced computer keyboarding skills.
Epic Referrals & Cadence.

Additional Details:Ability to work general business office hours, hours: Monday through Friday, 8AM – 4:30PM. Occasional need to come in early or stay late to accommodate patient or physician needs. Ability to work in a shared office space with multiple distractions. Hybrid position including on site and remote work.Benefits:

Healthcare Options - Covered 100% for full-time employees and 88% for dependents, and $25K of term life insurance provided at no cost to the employee

Two separate above market pension plans to choose from

Vacation- up to 200 hours per year depending on length of service

Sick Leave- up to 96 hours per year

8 paid holidays per year

Substantial Tri-met and C-Tran discounts

Additional Programs including: Tuition Reimbursement and Employee Assistance Program (EAP)

All are welcome: 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.

PAS Resource Specialist - Heart Transplant Managed Care Coordinator

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