PAS Resource Specialist at Oregon Health & Science University

Portland, Oregon, United States -

Full Time

Start Date

Immediate

Expiry Date

25 May, 26

Salary

34.95

Posted On

24 Feb, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Financial Screening, Patient Eligibility, Managed Care, Billing And Coding, Patient Referrals, Customer Service, Authorization Processing, Appointment Coordination, Triage, Training, Cross-Coverage, Data Entry, ICD10 Coding, Surgery Scheduling, Computer Skills, Communication

Industry

Higher Education

Description

Department Overview The Department of Neurological Surgery provides care to patients of all ages who have experienced neurological symptoms, neuro-trauma, or disorders of the nervous system requiring medical or surgical intervention. Diagnostic groups commonly cared for include: brain tumor, spinal tumor, brain injury, spinal cord injury, vertebral and/or spinal cord abnormalities, hydrocephalus, intracranial hemorrhage, craniovertebral junction abnormalities (CVJ), transient ischemic attack (TIA) or ischemic stroke, autoimmune disorders, Parkinson disease, seizures, headaches, episodic disorders, mental status changes, meningitis, encephalopathy, congenital disorders of the skull/spine/nervous system, and neurological problems involving respiratory compromise. The PAS Resource Specialist for the Department of Neurological Surgery supports a range of administrative and clinical support functions for the Department. The PAS Resource Specialist is responsible for providing leadership and guidance for PAS Specialists in the areas of financial screening, patient eligibility for services, managed care and other health care contract terms, billing and coding, and complex patient referrals. The PAS Resource Specialist will provide assistance in the use of the PAS network software. The PAS Resource Specialist gathers and records required information about patients; provides specific customer services which include screening for financial eligibility, confirming health insurance coverage and individual’s obligations, obtaining necessary authorizations for care, coordinating medical, surgical, and diagnostic test appointments, and assisting patients in an office and clinic setting. Duties include processing pre-authorization requirements with outside entities, handling incoming calls, processing new patient referrals, return visit requests, provider inquiries, as well as reviewing outpatient instructions with the patient and triaging phone calls related to patient care. This position may also provide instruction to PAS-S personnel on processes and procedures and will provide cross-coverage and fill-in coverage as needed for department PAS-S and PAS-R roles, as directed by the supervisory team. Pay Range: $25.86 - $34.95 per hour, Commensurate with Experience Function/Duties of Position 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. 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 on line, and manually if necessary. Obtains prior medical records and studies if appropriate. Creates a medical record 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. Point of Service Operations: Greets patients and confirms that appointments have been kept. Inspects insurance cards and/or authorization notices. Identifies and collects deductible payments, co-payments, and deposits on services; provides receipts and completes necessary accounting procedures including reconciliation and deposit of funds. Verifies and updates the common data set on-line. Explains and satisfies any necessary patient signature requirements. Validates parking. Integrated Care: Coordinates associated clinical, diagnostic, or laboratory services; obtains authorizations when necessary. Directs patients to appropriate providers for other health care issues. Completes and routes direct referrals to other clinical services. Contacts primary care physicians or their designees to obtain authorizations for urgent care. Schedules return appointments on line, and manually if necessary; initiates authorization 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. 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. Clinical Service Resource: Shares PAS expertise and disseminates PAS information to PAS Specialists and Trainees within the service area. Instructs co-workers as needed in user skills for PAS system software. Maintains a service-based working knowledge of diagnostic and procedural coding. Provide cross-coverage and fill-in coverage as needed for PAS-S and PAS-R roles as directed by the supervisory team. Personnel Operations: Gives instruction for other PAS personnel pertaining to PAS processes and procedures as well as performance. Provides on the job training, orientation, guidance and coaching for new PAS personnel in the service area. May be required to distribute PAS duties within a defined work-group and to review work for conformance to standards. May be required to provide informational assessment of other PAS workers’ performance to the PAS Coordinator/Supervisor and/or the employment supervisor. 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 ICD10 coding requirements and issues. Obtains managed care authorizations for all consultations, procedures, office visits, and care arrangements by scheduling appointments and contacting other providers’ offices. Surgery Scheduler: Maintains current information regarding surgery schedules for service site providers. Serves as liaison and information resource for physicians, nursing support staff, coworkers, IP Admitting Department, Surgery Office, and Periop Services. Collects from physician all information necessary to schedule a surgery (including ICD10 codes, equipment needs, etc.). Maintains surgery information to OR as soon as received. Starts insurance process and obtains authorizations. Facilitates care arrangements by scheduling peri-operative services, PMC clinic, ancillary and clinical services as needed. Applies problem solving and negotiating skills in resolving provider and patient concerns and other surgery related problems. Department Meetings, Process Improvement work, training/onboarding new staff. Administrative Responsibilities: Assist assigned providers with general non-medical scheduling requests, such as setting academic appointments, calendar upkeep using tools such as Outlook or Bridge, and assisting with other general administrative tasks as assigned. Required Qualifications One year of experience in a medical office setting, including high-volume direct patient contact, scheduling of appointments 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. The candidate must have a thorough knowledge of PAS policies and procedures. 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. Candidates will have demonstrated advanced PAS user skills as well as extensive knowledge of integrated care at OHSU. Applicants must have a positive attitude and compassion for patients experiencing difficult emotions arising from health care situations. Requires a self-directed and organized individual who can excel in a busy environment. Applicants must work effectively with providers, managers, and peers and exhibit excellent customer service and communication skills. Excellent verbal and composition skills and ability to convey detailed and complex medical information. Excellent proficiency in computer programs including MS Office (Excel, Word, Powerpoint, etc) and medical based compter programs. Typing skills of at least 45 words per minute. Thorough knowledge and experience with multi-line phones. Proven excellent work attendance record. Preferred Qualifications High school diploma Bachelor's degree Medical office experience in a neurological surgery department Knowledge of neurosurgery terminology. Formal customer service training. Surgery scheduling experience. Managed Care Coordination experience. Referral Coordination experience. Why apply to OHSU? 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.

Responsibilities

This specialist provides leadership and guidance to PAS Specialists on financial screening, eligibility, contract terms, billing, and complex referrals, while also assisting patients with scheduling, insurance confirmation, and obtaining authorizations for care. Duties involve processing pre-authorizations, handling incoming communications, reviewing instructions with patients, and triaging calls related to patient care.