Managed Care Coordinator

Description:

Managed Care Coordination: Maintains current information on managed care insurance plans and serves as liaison and information resource for physicians, nursing support staff, 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 managed care, coding requirements and issues, along with providing communication to support staff of any and all new processes. Applies problem solving and negotiating skills in resolving patient concerns and managed care related problems, to include satellite clinics as applicable. In addition, establishes benefits, utilizes contract information, OHSU policies and insurance carrier policies on managed care, coordinates referrals and authorizations on line and interprets managed care benefits to patients. Updated skills and information through meetings and workshops is necessary maintaining documentation of efforts.

Customer Service: Provide high quality customer service to both external customers (patients, referring providers, and insurance carriers) and internal customers (OHSU health care providers and support staff) that meets and/or exceeds the service standards of the health care industry. Seeks opportunities to improve the work and work environment to better meet the needs of internal and external customers. This duty includes prompt and professional communication efforts, face-to-face customer contact skills, crisis management, facilitate with available information, technology, standard complaint processing, flexible coverage of internal service needs and the continuous application of process improvement methods and skills. Notifies patients of authorization results and notifies physician/nurse if patient requires self-pay information.

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.
• 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.
• Demonstrated knowledge of managed care intricacies including appropriate timelines, paperwork, regulations, communication and follow-up are also required.
• Demonstrated problem solving and negotiation skills in resolving patient concerns, scheduling challenges, and managed care related problems.
• Demonstrated understanding of managed care.
• Demonstrated reliable attendance record.
• Working knowledge of managed care and referral and authorization processes.
• Working knowledge and understanding of medical terminology required.
• Ability to multi-task in a high volume situation.
• Ability to problem solve and retain pertinent information.
• Professional appearance and demeanor required.
• Ability to perform the job duties with or without accommodation.