Patient Access Specialist

PAS Resource Specialist– GAS Specialties Location: US-OR-Portland Salary Range: $27.78 - $37.54 per hour with offer based on experience, education and internal equity Contract Type: Full-Time Position Category: Hospital/Clinic Support Job Type: AFSCME union represented Position Type: Regular Full-Time Posting Department: Digestive Health Practice Posting Schedule: Monday - Friday Posting Hours: 8:00am - 4:30pm Posting FTE: 1.00 HR Mission: Healthcare Drug Testable: No The OHSU Digestive Health Center offers patients an interdisciplinary team approach to the prevention, detection, and treatment of digestive disorders. Our teams blend clinical expertise with research advances to achieve the best possible care and outcomes. The team includes patients, their referring physicians, and a wide range of OHSU specialists. The PAS Resource Specialist is responsible for providing the highest level of customer service while handling all aspects of care coordination support and the scheduling of clinic appointments, ancillary services and managed care for the Digestive Health Center (DHC) GAS Specialties Practice. This position will also be required to have working knowledge of managed care as it relates to the DHC and OHSU Managed care practice standards as well as knowledge of referral processing. This position will respond to patient care GAS Specialties scheduling requests which include but are not limited to, patient phone calls, and MyChart or provider request. This position will assist with the DHC telephone calls and voicemail processing as requested by management. This position also serves as a resource to Connected Care Center (C3) and DHC Frontline (PAS-S) staff regarding questions pertaining to scheduling/managed care/and protocols. Function/Duties of Position Customer Service: Provide the highest level of customer service to both external customers (patients and their families, referring providers, insurance carriers, etc.) and internal customers (OHSU health care providers and staff) that meet or exceed 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. Call Processing: Responsible for connecting the patient with the appropriate individual to progress their care in the clinic; Transfers calls to schedulers as needed, creates telephone encounters, contacts nursing coordinators, and pages providers and staff as needed per circumstance; Scheduling and managing of patient access to Digestive Health Center (DHC); Create telephone calls from patients in the EMR which will include accurate documentation of requests for medication refills, complaints, general informatin inquiries and urgent health care concerns; Triage calls to the appropriate staff for patient care /needs assessment; Process call (answering, screening, routing, paging etc.) in a timely, polite, professional manner; Route calls to appropriate conclusion; Provide information to callers, including directions, addresses and hours of operation; Use schedules and departmental procedures to locate appropriate on-call person for internal and external callers; Understand and process calls per departmental policy for each encounter type (ie refill, telephone, documentation, etc) Managed Care Coordination: Process all Managed Care functions for the GAS Specialties clinic visits, and non-OHSU imaging services; Maintains current information on managed care insurance plans and serve as a liaison and information resources for physicians, nursing support staff, co-workers, referring physicians offices, patients and insurance companies on authorization requirements per diagnosis and service. Gather and/or verify patient information including demographics, insurance coverage, and financial status in accordance with OHSU and OHSU UMG best practices. Confirm patient eligibility for health care coverage and clarify any managed care arrangements. 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 OHSU EMR system in accordance with OHSU and OHSU UMG best practices. Obtain authorizations for clinical care, capsules, and all ancillary studies. Applies problem solving and negotiating skills in resolving patient concerns and managed care related problems. Follow up on pending authorizations until they are obtained. Referral Processing:Process incoming referrals to the GAS Specialties. Assure that demographics are correct (i.e. address, contact numbers, PCP, etc). Print off material from Epic related to reason for the referral. Create Earl shell filling in all fields possible. If missing important medical information, contact the referring office to request it. Document in Earl the status of the referral and who it is going to review with/where it is located if we are waiting for additional information that will be needed prior to the medical review. Create a packet of information for the reviewing provider / RN. Document status of referral and who referral has be sent to for review. Send packets to appropriate person for medical review once records needed are obtained. Organize medical information that is easily reviewable marking specific types of records. Manage referrals that C3 is unable to process that fall in the Needs Clinic Action work queue. Scheduling: Coordinate patient care appointments and managed care as directed by physician and/or nurse staff; Serves as a liaison and information resource for physicians, and nursing support staff; Return phone messages; Prepare and mail new patient information packets; Direct patients to appropriate providers for other health care issues; Complete and route direct referrals to other clinical services; Enter patient information accurately into Epic when necessary; Proper use of OHSU forms and documentation required for all patients. Works with providers to maintain current clinic templates to include blocking schedules in Epic in a timely manner. Assist C3 in scheduling pts that require decision making options not available to the C3 Schedulers. Integrated Care: Obtain prior medical records and studies on complicated patient cases per nurse review on the majority of incoming patients; Responsible for obtaining, recording, tracking, and verifying referrals and authorizations for the respective outpatient clinic and lab visits when necessary. 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. Preferred Qualifications Advanced Degree Experience working with an electronic health record. Scheduling Experience. Experience working in a Gastroenterology clinicMedical terminology. Ability to learn new computer sills and systems. Additional Details Monday-Friday 8:00am-4:30pm.This position works in a busy environment with many interruptions, multiple demands and interactions.This position will handle a high volume of patient phone calls, high level of multi tasking, and scheduling. #J-18808-Ljbffr