Managed Care Coordinator

OHSU Dermatology is located in the Center for Health & Healing on the South Waterfront in Portland, Oregon. The Department of Dermatology is dedicated to providing our patients the best and most innovative dermatologic care for the broad range of skin, hair, nail, and mucous membrane disorders.

The PAS Resource Specialist acts as guidance for PAS Specialists, PAS Trainees and other staff in the areas of health care contract terms, complex patient referrals, and other Managed Care issues. This position is also responsible for Managed Care authorizations for all consultations, procedures, office visits and care arrangements. Provides and assists with implementation and communication to support staff of new processes within the department, as needed. Works cooperatively and productively with others to achieve shared goals.

The PAS Resource Specialist will provide assistance in the use of the PAS network software. Experience with OHSU network applications, to include EARL, Cadence, and viewing of Prelude preferred. This position performs in a manner which maintains the confidentiality and privacy of each patient, promotes positive health habits through appearance and attitude. Supports and adheres to the Code of Conduct and Policies and Procedures of both OHSU Hospital and clinics and the Department of Dermatology; models ethical and appropriate behavior, professional standards, compliance and personal integrity; adheres to the rules and regulations.

Pay Range: $24.62 - $33.28 per hour

Enrollment and Authorization: Verify patient information including demographics, insurance coverage and financial status. Confirm patient eligibility for health care coverage and clarify any Managed Care arrangements. Obtain authorizations for all clinical care, procedures, and laboratory studies, to include providers at onsite and offsite clinics. Enter all information accurately into OHSU databases. Follow-up on pending authorizations until they are obtained. In addition, integrate care by obtaining authorizations for other associated clinical diagnostic or laboratory services. Contact primary care physicians or their designees to obtain authorizations for urgent care.

Managed Care Coordination: Maintains current information on Managed Care insurance plans and serves as liaison and information resource for physicians, nursing support staff, 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 Managed Care, coding requirements and issues, along with providing communication to support staff of any and all new processes. Applies problem solving and negotiating skills in resolving patient concerns and Managed Care related problems, to include satellite clinics as applicable. In addition, establishes benefits, utilizes contract information, OHSU policies and insurance carrier policies on Managed Care, coordinates referrals and authorizations on line and interprets Managed Care benefits to patients. Updated skills and information through meetings and workshops is necessary maintaining documentation of efforts.

Customer Service: Provide high quality customer service to both external customers (patients, referring providers, and insurance carriers) and internal customers (OHSU health care providers and support staff) that meets and/or exceeds the service standards of the health care industry. Seeks opportunities to improve the work and work environment to better meet the needs of internal and external customers. This duty includes prompt and professional communication efforts, face-to-face customer contact skills, crisis management, facilitate with available information, technology, standard complaint processing, flexible coverage of internal service needs and the continuous application of process improvement methods and skills. Notifies patients of authorization results and notifies physician/nurse if patient requires self-pay information.