The PAS Resource Specialist is responsible for assuring Financial Clearance that appointments and ordered services will be covered by the patient’s insurance, or if uninsured, the patient is referred appropriately to obtain necessary support. The PAS Resource Specialist provides managed care services for the work unit by providing excellent customer service through prompt and professional communication skills, occasional face-to-face customer contact skills, and excellent problem-solving skills. The PAS Resource Specialist also works with patients to help them to understand their insurance benefits and payment obligations. The PAS Resource Specialist works directly with providers, clinical and office staff to obtain information to carry out job duties.
Function/Duties of PositionKey Responsibilities & Performance Standards
Verifies insurance eligibility and obtains benefits, referrals/prior authorizations and documents in patient’s file. Updates insurance information on patient’s accounts when applicable.Uses Epic Work-queues and schedules to obtain authorizations for ancillary service referrals and documentation of such.Reviews orders and documents treatment approvals and locations in patient’s record (EMR). Monitors all treatment regimens for insurance coverage and appropriateness of indication and forwards to Manager/Formulary Committee for approval as needed. Functions as a “point of inquiry” and resource for all work unit staff with questions regarding insurance coverage and where scans and treatments may be done.Applies problem solving and negotiating skills in working with insurance companies and referring providers to obtain a successful outcome.Performs financial counseling with patients prior to treatment and calculates co-insurance amounts as requested or obtains costs of treatment for ABN preparation.Reviews additions to the schedule of same day and next day appointments from outside OHSU providers for insurance and authorizations of medications to infuse in the day treatment clinic. Performs research and processes paperwork for financial assistance foundations to help patients pay for specialty drugs.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 (dependent on position description). 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 High School Diploma or GEDAssociate Degree or higher; minimally some college coursework in related fieldExperience in working with chemotherapy drugs in medical oncology settingKnowledge of computer applications including Epic Cadence, and EARL Additional DetailsThis position works in a busy office environment with multiple, competing demands; frequent interruptions, and interpersonal interactions with both internal and external customers. Hours: 8:30 am - 5:00 pm, M-F. Position requires employee to travel occasionally between the various offices of the OHSU Radiation Oncology work unit. Position is eligible for work-from-home following expectations and protocols.
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.