PAS Resource Specialist - Heart Transplant Managed Care Coordinator

Department Overview

This PAS Resource Specialist position is responsible for accurately managing a large volume transplant patient population and providing support for Clinical Transplant services. This position requires significant attention to detail and accuracy, quality assurance, and multi-disciplinary team communication. Duties include scheduling and coordination of visits, diagnostics, infusions, and other outpatient services as required; obtain prior authorizations as needed; referral coordination for post-transplant transfer-in patients; professionally documenting in a patient’s electronic medical record; lab entry, and other outpatient services as required; professionally documenting in a patient’s electronic health record; screening program related phone calls (patients, referring physicians, OHSU Staff, and insurance carriers); management of work queues to meet OHSU metric standards; frequently communicating to the multidisciplinary team; and provides assistance to patients, functioning as the liaison for insurance plans, providers, and care team members. This position requires significant attention to detail, accuracy, and timeliness as many of the job functions are to meet regulatory requirements. This position is vital for the efficient operation of a complex work unit.

Function/Duties of Position

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 coding requirements and issues.
• Obtains managed care authorizations for all consultations, procedures, office visits, and care arrangements by scheduling appointments and contacting other ancillary and clinical services as needed, while considering fiscal impact.
• Applies problem solving and negotiating skills in resolving patient concerns and managed care related problems.

Arranged Care

• Schedules new patient appointments. Obtains prior medical records and studies if appropriate. Creates medical records 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.

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.

Referral Coordination

• Maintain and track incoming post-transplant patient referrals. Process referral according to OHSU standards. Applies problem solving and negotiating skills in resolving patient concerns and referral related problems.

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 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.
• Must be able to perform the essential functions of the position with or without accommodation

Preferred Qualifications

• Prefer BS or BA in any area.
• Cardiology and/or organ transplant medical office experience. 
• Knowledge of OHSU system software including EPIC, Phoenix, and electronic eligib