[Hiring] Managed Care Coordinator @Oregon Health & Science University

Role Description

This position is responsible for managed care, insurance verification and patient price estimate processes within the Centralized Managed Care & Price Estimates (CMC) department. This position supports the OHSU systems and operations of ambulatory practices, professional services and hospital departments. This position works closely with internal and external customers including:

• Intake Coordinators
• Clinical Staff
• Surgery Schedulers
• Care Managers
• Financial Counselors
• Insurance Companies
• PCP Office Staff
• CMC Leadership

The Managed Care Coordinator and Insurance Verification & Patient Estimates Specialist are an integral part of the CMC team by providing clear and accurate information regarding our patients' financial obligations related to their visits, treatments, procedures and/or hospital admissions. This role is responsible for:

• Obtaining and/or verifying prior authorizations
• Verifying benefits
• Creating cost estimates
• Contacting patients to provide estimates
• Offering pre-service payment opportunities
• Collecting pre-service payments for visits, treatments, procedures and/or hospital admissions

This position is also responsible for providing guidance for other staff in the areas of patient liabilities, health care contract terms, complex patient referrals, and other managed care issues.

The incumbent will have an extensive knowledge of Managed Care and Insurance Verification processes in the ambulatory and inpatient setting including but not limited to:

• Insurance eligibility
• Benefits verification
• Authorization requirements

This role is knowledgeable about the Epic system and current best practice referral and prior authorization workflows. The incumbent is able to provide support and backup to the Centralized Managed Care & Price Estimates Department as needed for cross-coverage for all managed care and insurance verification workflows.

Qualifications

• One year of experience in a medical office setting in a managed care position, including high-volume scheduling of appointments, multi-line phone system, medical terminology, verifying medical insurance and 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.

Requirements

• Thorough knowledge of PAS policies and procedures.
• Demonstrated advanced PAS user skills as well as extensive knowledge of integrated care at OHSU.
• Thorough knowledge of managed care policies and procedures, as well as authorization and referral processes in EPIC.
• Thorough knowledge of verifying medical insurance including worker’s comp and third-party liability.
• Experience with electronic scheduling, managed care websites and electronic medical record systems.
• Basic computer skills, including MS Word, Excel and Access, OHSU Epic skills and online resource use knowledge.
• Excellent communication skills, both written and verbal.
• Demonstrated knowledge of managed care and insurance verification policies and procedures including appropriate timelines, paperwork, regulations, communication and follow-up.
• Demonstrated efficiency, problem solving and negotiation skills in resolving patient concerns and managed care/insurance related problems.
• Ability to multi-task in a high-volume situation.
• Strong attention to detail and processes.
• Ability to work autonomously, with a high level of accuracy, speed and exhibit a willingness to work with deadlines.
• Strong customer service orientation.
• Demonstrated effectiveness in confrontational customer interactions.

Benefits

• Healthcare for full-time employees covered 100% and 88% for dependents.
• $50K of term life insurance provided at no cost to the employee.
• Two separate above market pension plans to choose from.
• Vacation - up to 200 hours per year dependent on length of service.
• Sick Leave - up to 96 hours per year.
• 9 paid holidays per year.
• Substantial Tri-Met and C-Tran discounts.
• Employee Assistance Program.
• Childcare service discounts.
• Tuition reimbursement.
• Employee discounts to local and national businesses.