Department Overview:
This position is responsible for managed care, insurance verification and patient price estimate processes within the Centralized Managed Care & Price Estimates (CMC) department. This position supports the OHSU systems and operations of ambulatory practices, professional services and hospital departments. This position works closely with internal and external customers including Intake Coordinators, Clinical Staff, Surgery Schedulers, Care Managers, Financial Counselors, Insurance Companies, PCP Office Staff, and CMC Leadership to ensure patients receive optimal financial services related to their care.
The Managed Care Coordinator and Insurance Verification & Patient Estimates Specialist are an integral part of the CMC team by providing clear and accurate information regarding our patients¿ financial obligations related to their visits, treatments, procedures and/or hospital admissions. This role is responsible for obtaining and/or verifying prior authorizations, verifying benefits, creating cost estimates, contacting patients to provide estimates, offer pre-service payment opportunity and collecting pre-service payments for visits, treatments, procedures and/or hospital admissions. This position is also responsible for providing guidance for other staff in the areas of patient liabilities, health care contract terms, complex patient referrals, and other managed care issues.
The incumbent will have an extensive knowledge of Managed Care and Insurance Verification processes in the ambulatory and inpatient setting including but not limited to insurance eligibility, benefits verification and authorization requirements. This role is knowledgeable about the Epic system and current best practice referral and prior authorization workflows. The incumbent is able to provide support and backup to the Centralized Managed Care & Price Estimates Department as needed for cross-coverage for all managed care and insurance verification workflows.
Function/Duties of Position:

KNOWLEDGE, SKILLS, AND ABILITIES

• 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.
• The candidate must have a thorough knowledge of managed care policies and procedures, as well as authorization and referral processes in EPIC.
• The candidate must have a thorough knowledge of verifying medical insurance including worker’s comp and third party liability.
• Candidates will have demonstrated advanced managed care user skills.Experience with electronic scheduling, managed care websites and electronic medical record systems.
• Advanced computer skills, including MS Word, Excel and Access, OHSU Epic skills and online resource use knowledge.
• Excellent communication skills, both written and verbal.
• Demonstrated knowledge of managed care and insurance verification policies and procedures including appropriate timelines, paperwork, regulations, communication and follow-up are also required.
• Demonstrated efficiency, problem solving and negotiation skills in resolving patient concerns and managed care/insurance related problems.
• Must meet Department performance standards measuring efficiency, production, timeliness and accuracy. This will be reviewed on a regular basis both as a team and as an individual.
• Ability to multi-task in a high volume situation.
• Strong attention to detail and processes.
• Ability to work autonomously, with a high level of accuracy, speed and exhibit a willingness to work with deadlines.

Preferred Qualifications:

• High School Diploma or GED.
• Excel skills and knowledge preferred.

Additional Details:
Work Schedule: Monday - Friday, 8 hour shift during operational hours 7:00am - 5:30pm.
Work location: Downtown Portland (Fifth Avenue Building)/Teleworking. Must be able to share office space with other coworkers and able to multi-task in a high-volume environment.

Required Qualifications:

• One year of experience in a medical office setting in a managed care position, including high-volume scheduling of appointments, multi-line phone system, medical terminology, verifying medical insurance and 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

Required Qualifications:

• One year of experience in a medical office setting in a managed care position, including high-volume scheduling of appointments, multi-line phone system, medical terminology, verifying medical insurance and 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.