PAS Resource Specialist at Oregon Health & Science University

Portland, Oregon, United States -

Full Time

Start Date

Immediate

Expiry Date

30 Jul, 26

Salary

36.35

Posted On

01 May, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Patient scheduling, Insurance verification, Managed care, Medical terminology, Data entry, Customer service, Electronic health records, Referral processing, ICD10 coding, CPT coding, Authorization requests, Multi-tasking, Communication skills, Problem solving, Negotiation

Industry

Higher Education

Description

Department Overview 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. The Bariatric Services Program offers warm, caring and efficient service to all patients and customers. The Patient Navigator in this position is responsible for handling all aspects of scheduling the Bariatric Surgery patient experience at the Digestive Health Center clinics. The Patient Navigator is responsible for intake and scheduling coordination for Bariatric Patients coming to OHSU. The purpose of the position is to assist patients with scheduling and coordinating outside visits and testing as they pursue their goal of bariatric surgery. This position will work closely with the other PAS team members, other OHSU departments, and community partners at AH and HMC, to achieve the overall goals of the program. Function/Duties of Position Referral Processing & Managed Care: 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. Educates patients of pre-pay amounts, monitors provider’s schedules and other managed care duties as assigned. Fills out patient financial responsibility forms when necessary. Enters all information accurately into OHSU databases or into the medical record when necessary. 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 as needed. Apply problem solving and negotiating skills in resolving patient concerns and managed care related problems. Follow up on pending authorizations until they are obtained as needed. Cover and / or support with benefit checks, essentially acting as a “bridge” between MCC team and BAR team to clarify incorrect benefit checks. Assist in maintaining insurance spreadsheet up to date in excel. Assist in calling patients prior to intake to go over insurance requirements for surgery. 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 as needed. 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. Process incoming referrals to the Bariatric Surgery Department. Assure that demographics are correct (i.e. address, contact numbers, PCP, etc.). Create referral shell filling in all fields possible. If missing important medical information, contact the referring office to request it. Document in Earl the status of the referral and who it is going to review with/where it is located if we are waiting for additional information that will be needed prior to the medical review. Document status of referral and who it is going to review with. Work with providers on medical review once records needed are obtained. Organize medical information that is easily reviewable marking specific types of records. Enrollment and Arranged Care: Enrolls patients and create patient charts when needed. Schedules New and return patient appointments and coordinates any ancillary appointments. Creates referral in Epic, provides cross-coverage of other Bariatric positions that would require facilitating medical review and other scheduling tasks. Obtains prior medical records and studies for Bariatric Checklists. Arranges stretchers, wheelchairs, and interpreters when necessary, and accommodates other special needs whenever possible. Mails information packets to patients. Maintains knowledge of insurance plan criteria such as diet requirements for Bariatric patients, this information is relied to patients and clinical staff. Coordinates and navigates with patients to ensure they do not miss monthly visits and stay on track with surgery timeline. When co-workers are out covers new patient referrals, surgery scheduling, and managed care. Reviews insurance and co-morbidities determining if patients qualify. Emails new patient information to start process. Supports in collecting accurate scheduling and registration information. Talks with insurance case managers to discuss requirements. Talks with Primary care offices to answer pathway processes to surgery. Work to resolve roadblocks for patients by consulting with team and partnering with other departments to ensure timely completion of patient’s requirements before surgery. 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 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. Preferred Qualifications HS Diploma or Equivalent Bachelor’s Degree Experience working with an electronic health record. Experience working in and administrative assistant capacity. Experience working in a Gastroenterology clinic Medical terminology. Ability to learn new computer sills and systems. Additional Details This position works a hybrid position 95% from home. Employees come onsite for team days, meetings, and requested clinics. This position will involve a high level of multi-tasking, and scheduling. Work schedule is Monday – Friday, 8:30am – 5:00pm. Why apply to OHSU? 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

Responsibilities

The Patient Navigator is responsible for coordinating the scheduling and intake process for bariatric surgery patients within the Digestive Health Center. This role involves verifying insurance coverage, obtaining necessary authorizations, and maintaining clear communication with patients and clinical staff throughout the surgical pathway.