PAS Resource Specialist

Since its inception, the OHSU Transplant Program has expanded to include kidneys, heart, liver, and pancreas. The team transplants more than 200 organs a year. Over the years, thousands of people with life-limiting disease have been saved thanks to organ transplantation at OHSU. And along the way, the transplant team has actively contributed to new transplant technologies, including: surgical techniques, organ retrieval and preservation, donor and recipient matching, recipient preparation, chronic immunosuppression regimens, and prevention and treatment of complications.

Job Summary 

As the PAS Resource Specialist, you will be responsible for providing administrative support for Clinical Transplant Services Financial Review team. Duties include reviewing financial eligibility for new and existing transplant patients in close working partnership with the financial counselor; maintaining extensive knowledge of insurance benefits; maintaining up-to-date information regarding transplant related expenses, contracting changes, etc and updating the PAS team as appropriate; screening referrals for VA benefits; managing single case agreement requests; managing financial requirement tracking; reviewing eligibility for assistance programs and maintaining grant system documentation as required; troubleshooting complex medication coverage issues; fielding insurance/financial questions from patients; professionally documenting in a patient’s electronic health record; screening program related phone calls (patients, referring physicians, OHSU Staff, and insurance carriers); management of work queues to meet OHSU metric standards; and frequently communicating to the multidisciplinary team. In this position you will be responsible for accurately managing a large volume transplant patient population. You will act as coverage for financial counselor during any absences.

Roles and Responsibilities 

Managed Care Coordination

• Maintains current information on managed care insurance plans and serves as a liaison and information resources for physicians, nursing support staff, pharmacies and 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 coding requirements and issues. Assists in obtaining managed care authorizations for all consultations, procedures, office visits, prescriptions, and care arrangements. Applies problem solving and negotiating skills in resolving patient concerns and managed care related problems.

Enrollment & Authorization

• Gathers and/or verifies patient information including demographics, insurance coverage, and financial status. Confirms patient eligibility for health care coverage and assistance programs and clarifies any managed care arrangements.
• Obtains authorizations for clinical care, procedures, and laboratory studies. Enters all information accurately into OHSU databases or into the medical record when necessary.
• Assists with enrollment in assistance programs. Follows up on pending applications until they are obtained.

Clinical Service Resource

• Shares PAS Resource Specialist expertise and disseminates PAS information to PAS Resource Specialists and Trainees within the service area.
• Instructs co-workers as needed in user skills for PAS system software including thorough understanding and advanced EPIC skills.
• Maintains a service- based working knowledge of diagnostic and procedural coding. Fills in as needed for any subordinate PAS position within the service areas.

Telecommunications

• Triages and documents accurately telephone calls from patients including insurance-related questions, financial concerns, complaints, general information inquiries, and urgent health care concerns. Delivers such information or requests promptly to the appropriate providers or their designees.

Required Qualification

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

Preferred Qualification

• Organ transplant medical office experience.
• Knowledge of OHSU system software including EPIC, Phoenix, and electronic eligibility systems.