Patient Navigator (PAS Resource Specialist)

Department Overview

The Transgender Health Program offers welcoming, respectful, gender affirming and efficient service to all

patients and customers. The PAS Specialist in this position is responsible for handling all aspects of managing

general inquires, incoming referrals, managed care activities, and coordination of care within the Episode of

Care for patients accessing services under the Transgender Health Program umbrella.

 

The PAS Resource Specialist is responsible for and scheduling intake visits with Transgender Health Program social work and psychology visits where indicated and will help coordinate and assist patients with scheduling and coordinating of other visits across OHSU clinics as they pursue their goal of gender affirming care. This position will work closely with the other PAS team members in Endocrinology (adult/peds), Gynecology, Plastic Surgery, Otolaryngology, Dermatology, Family Medicine, Adolescent Medicine, Psychiatry and others as needed to support overall goals of the program.

Function/Duties of Position

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 Transgender Health Program teams 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. 

Enrollment and Arranged Care:

• Enroll patients and create patient charts when needed. Schedule New and return patient appointments and coordinates any ancillary appointments. Create referral in Epic, provide cross-coverage of other Transgender Health Program positions that would require facilitating medical review and other scheduling tasks. Obtain prior medical records and studies for Transgender Health Program Checklists. Arranges interpreters when necessary, and coordinate with Transgender Health Program clinics and staff to accommodate other special needs whenever possible.
• Mails information packets to patients. Knowledge of insurance plan information such as gender affirming surgery pre-requisites such as WPATH letters of support and WPATH current guidelines as well as attendance at patient education classes. Coordinate and navigate with patient and other Transgender Health Program clinics and staff to ensure they are meeting requirements for surgery eligibility.
• Email new patient information to start process. Send to Registration Department if they need to update their insurance. 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 or other gender affirming medical procedures.

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 requires experience obtaining managed care authorizations. OR
• One and a half year of work experience in a hig