Managed Care Coordinator (PAS Resource Specialist)

Department Overview

Family Medicine at South Waterfront is a community based clinic offering primary care and specialty services for all types of patients. We treat everyone--babies, children, adolescents, adults (including moms-to-be), and seniors. Our services include maternity care (including deliveries), women's reproductive health, behavioral health care and counseling, transgender care, pediatric care, travel immunizations, podiatry, sports medicine, acupuncture, minor procedures, and health maintenance with preventive care. Between 200 and 275 patients are seen per day by our 40 plus providers assisted by 60 plus staff members.

 

The Managed Care Coordinator (MCC) at Family Medicine at South Waterfront is responsible for handling all

aspects of the authorization process. The MCC processes incoming and outgoing department referrals along

with prior authorizations for diagnostic services. This will include gathering appropriate and correct patient

demographics, financial information, chart notes and other supporting documentation, and confirming correct

health coverage.

Function/Duties of Position

• Manages referral work queues and processes. Is responsible for verifying patient eligibility and securing referral/authorization prior to the outpatient appointment. The authorization process includes, but is not limited to,

  putting the referrals information on-line, following up on referrals for return appointments, and other miscellaneous tasks. This task includes management of the referral process from start to finish meeting or exceeding the appropriate service standards.

• Gathers and/or verifies patient information including demographics, insurance coverage, and financial status. Confirms patient eligibility for health care coverage. Obtains prior authorizations for clinical care, procedures and diagnostic studies as appropriate. Enters all information accurately into Epic. Follows up on pending authorizations until they are obtained. Updates referral work queue.

• Back up for answering phones and scheduling appointments as necessary;

  additional coverage for front desk duties as needed.

• Maintains current information on all managed care insurance plans and is up-to-date with all managed care insurance plan changes, utilizing information to efficiently and effectively obtain authorizations.

• Other Duties as applied

Required Qualifications

• One year of experience in a medical office setting, including high-volume direct patient contact, scheduling of appointments and requires 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.

Preferred Qualifications

• High school diploma or equivalent.
• Previous Epic experience.

Additional Details

Exposure to ill patients - flu, colds, virus. Must be able to sit for long periods, move about the clinic as necessary, and use telephone and computer for extended periods of time.