Patient Estimates and Insurance Verification Specialist (PAS Resource Specialist) - #156411

OHSU


Date: 02/23/2021 16:00 PM

City: Portland, Oregon

Contract type: Full Time

Work schedule: Full Day

Department Overview


The Patient Estimates & Insurance Verification Specialist position is responsible for securing all patient accounts of patients admitted to the facility as day, observation, and/or inpatient status. Verify third party insurance eligibility and benefits. Verify pre-authorizations, authorizations, and/or Primary Care Provider (PCP) referrals for services provided. Act as a resource to patients, family members, and other departments in relation to questions and concerns around the insurance verification process. Responsible for providing patients with an estimate of the cost of care for upcoming visits, procedures, and admissions. Verify the patient's benefits and perform other standard managed care processes as needed in order to create an accurate estimate. Provide customer service to the patient to explain/discuss the estimate with the patient. 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. This position works closely with the CMC Managed Care Coordinators and Financial Counselors to ensure patients receive optimal services related to their care at Oregon Health & Science University.


This position serves as a member of the Centralized Managed Care department, which is responsible for supporting the systems and operations of ambulatory practices, professional service and hospital departments.


Function/Duties of Position


Insurance Verification:



  • Obtains benefit information including current eligibility, deductible or co-pays, co-insurance, stoploss or out of pocket status, authorization requirements, PCP referral requirements, days approved (for routine admissions), and correct billing address.
  • For urgent/emergent admissions, provides admit information and sets up authorizations and/or PCP referrals. Contacts care-management to provide clinical review and obtain length of stay.
  • For routine admissions, confirms that the authorizations and/or PCP referrals cover the designated admission. If authorizations and/or PCP referrals are not noted in the system, contacts the Managed Care Coordinator from specialist's office requesting the admission for follow up with the designated insurance company.
  • Follow up on all pending authorizations and/or PCP referrals until accounts are secured.
  • Maintains current information on managed care insurance plans and serves as a liaison and information resource for patients, referring physician offices, and other OHSU staff. Applies problem solving and negotiating skills in resolving patient concerns and managed care related issues.
  • Collects detailed information of trauma admissions (motor vehicle accident, personal injury, and/or worker's compensation) to determine accident-related liability.
  • Appropriately codes insurance plans in EPIC system for billing purposes.

Patient Liability Estimates:



  • Review work queue for patients that need an estimate created.
  • Document information based on department protocols in the Epic referral shell.
  • Create a Patient Liability Estimate.
  • Complete accurate pre-registration via phone.
  • Contact the patient prior to admission to inform them of their estimate and collect any pre-payments at that time.

Customer Service:


At all times must exemplify high quality customer service to both external customers as well as internal customers that meets or exceeds the service standards as set by OHSU. This duty includes prompt and professional communication efforts, high level conflict resolution, flexible coverage of internal service needs, continuous application of process improvement methods and skills, crisis management, & developing a standard complaint process for process improvement.


Other duties as assigned.


Required Qualifications


Experience:



  • At least one year of experience in a medical office setting, including high-volume of medical admissions, medical terminology and verifying medical insurance.
  • The candidate must have a thorough knowledge of PAS policies andprocedures. Candidates will have demonstrated advanced PAS user skills as well as extensive knowledge of integrated care at OHSU.
  • The candidate must have a thorough knowledge of verifying medical insurance including worker's comp and third party liability.
  • Experience with medical insurance websites for verifying eligibility, benefits and authorizations.

Job Related Knowledge, Skills and Abilities:



  • Advanced computer skills, including MS Word, Excel and Access skills and online resource use knowledge.
  • Excellent communication skills, both written and verbal
  • Demonstrated knowledge of insurance verification policies and procedures including appropriate timelines, regulations, communication and follow-up are also required.
  • Demonstrated efficiency, problem solving and negotiation skills in resolving patient concerns and medical insurance related problems.
  • Must meet Department performance standards measuring efficiency, production, timeliness and accuracy. This will be reviewed on a regular basis both as a team and as an individual.
  • 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.

Compliance:



  • Code of conduct
  • Respect in the workplace
  • Applicable policies, procedures and agreements related to position, department or OHSU as a whole.

Must be able to perform the essential functions of the position with or without accommodation.


Preferred Qualifications



  • High School Diploma or GED.
  • OHSU Experience.
  • Epic Skills and Knowledge.

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.

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