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 inquiries, 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 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 serves as a liaison and information resource 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 coordinate 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. Talk with insurance case managers to discuss requirements. Talk 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 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. Preferred Qualifications High School Diploma or Bachelor’s Degree preferred 2 years of experience working in a social service or customer service setting for transgender or gender diverse individuals. Experience working with an electronic health record. Experience working in an administrative assistant capacity Medical terminology Knowledge Ability to learn new computer skills and systems. Additional Details This position works in a busy multi-disciplinary and multi-clinic environment. This position will involve a high level of multi-tasking, and scheduling. Work schedule may include some weekend or evening activity 1-2x per month. OHSU welcomes people of all ages, ethnicities, genders, national origins, religions and sexual orientations. We are striving to build an anti-racist, multicultural institution and encourage people with diverse backgrounds to apply. To request reasonable accommodation, contact View email address on click.appcast.io. #J-18808-Ljbffr