Managed Care Coordinator/Ect Scheduler (Pas Resource Specialist)

Department Overview
The Adult Outpatient Psychiatry Clinic offers expert consultation, evaluation, and treatment for various mental health conditions, including depression, anxiety disorders, OCD, post-traumatic stress disorder, ADHD, and others. We also provide outcome-based measurement care to support patient-centered best practice treatment. We have the resources of an academic health center to handle complex conditions that require ongoing psychotherapy, medication management, and options for treatment-resistant depression, such as Electroconvulsive Therapy (ECT). Our clinic also offers neuropsychological and pharmacogenetics testing.
The Psychiatry PAS Resource Specialist: Managed Care Coordinator/ECT Scheduler plays a vital role as a multi-disciplinary team member in the Adult Psychiatry Outpatient Clinic. This position is the primary contact for the Psychiatry Hematology and Oncology Clinic (Psy HemOnc) and the Electroconvulsive Therapy Clinic (ECT) in the Department of Psychiatry. This position is responsible for processing internal and external referrals directed to the Psy HemOnc and ECT Clinics, performing all routine Managed Care functions such as verifying eligibility and benefits and securing authorization with a variety of insurers, and creating price estimates from the Out of Network No Surprise Billing and Self- pay No Surprise Billing Workqueue in Epic. The PASR will be able to provide and have knowledge of financial screening, patient eligibility for services, Managed Care and other health care contract terms, billing and coding, and complex patient referrals. The PASR informs patients about the billing mechanism and their financial liability for department services. The PASR will work closely with the providers in these clinics to provide exceptional care for patients by triaging and escalating complex issues and general concerns and questions as appropriate. The PASR will answer incoming patient's calls and return calls within 24 hours of initial contact. This position occasionally provides coverage for the general Adult Psychiatry Outpatient Clinic.
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 ICD9 and ICD10 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. Applies problem solving and negotiating skills in resolving patient concerns and Managed Care related problems.

ECT 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 ICD9 codes, equipment needs, etc.). Maintains surgery information to OR as soon as received.
• Starts insurance process and obtains authorizations. Facilitates care arrangements by scheduling preops, PAT clinic, ancillary and clinical services as needed. Applies problem solving and negotiating skills in resolving provider and patient concerns and other surgery related problems.

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

Clinical Service Resource:

• Shares PAS expertise and disseminates PAS information to PAS Specialists within the service area. Instructs co-workers as needed in user skills for PAS system software including RSS, Order Entry, LCR, EAD, and the Minimal and Common data sets. Maintains a service-based working knowledge of diagnostic and procedural coding. Fills in as needed for any subordinate PAS position within the service areas.

Telecommunications:

• Triages calls and faxes from patients, families, physicians, and pharmacies; transfers calls to appropriate provider line and/or pages information regarding cancellations and rescheduled appointments; communicates medication refills appropriately; triages consult, general information, complaints, and intake requests appropriately; communicates promptly with clinic manager any events or information pertinent to clinic operations.

Required Qualifications

• One year of experience in a medical office setting, including high-volume direct patient contact, scheduling of appointments and may require 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
Education:

• One year of work experience with insurance AND one year of work experience in a psychiatry office setting. ECT Experien

Job Related Knowledge, Skills and Abilities (Competencies):

• Firm command of insurance business practices; general knowledge of mental health practices;
• Scheduling of appointments and obtaining Managed Care authorizations;
• Patient advocacy skills;
• Excellent organizational skills and attention to detail;
• Excellent decision-making skills
• Knowledge of OHSU's PAS policies and procedures. Strong command of psychiatric insurance practices;
• General knowledge of community mental health resources.

All are welcome
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.