Clinical Specialist
Full Time
Portland, OR 97239
Posted Just posted
Job description
Department Overview:
As the Patient Access Resource Specialist (PASR) you will gather and record required information about patients, provides customer services which includes confirming health insurance coverage, determining individual financial obligations, verifying that necessary authorizations for care have been obtained, scheduling physician office appointments, cancer treatment appointments, and ancillary appointments, and assisting patients in an office or practice setting. You may be responsible for scheduling a high volume of complicated patient procedures and clinic appointments. You will serve as a liaison and information resources for physicians, nursing support staff, and coworkers, referring physician offices, patients and insurance companies on referral requirements per diagnosis and service. This role will be required to answer incoming calls to the clinic, to schedule, transfer, or triage to a clinical team. This role will explain detailed complicated procedures to patients and answer any patient questions or concerns within scope. Works closely with other medicine/surgery clinics for appointment coordination. Works reschedule and wait lists when necessary; Prepare and mail, fax, or email new patient information packets when necessary; Direct patients to appropriate providers for other health care issues; Complete and route direct referrals to other clinical services; Enter patient information accurately into the electronic medical record when necessary.
Function/Duties of Position:
OHSU is Oregon’s only public academic health center. We are a system of hospitals and clinics across Oregon and southwest Washington. We are an institution of higher learning, with schools of medicine, nursing, pharmacy, dentistry and public health – and with a network of campuses and partners throughout Oregon. We are a national research hub, with thousands of scientists developing lifesaving therapies and deeper understanding. We are a statewide economic engine and Portland’s largest employer. And as a public organization, we provide services for the most vulnerable Oregonians, and outreach to improve health in communities across the state.
As the Patient Access Resource Specialist (PASR) you will gather and record required information about patients, provides customer services which includes confirming health insurance coverage, determining individual financial obligations, verifying that necessary authorizations for care have been obtained, scheduling physician office appointments, cancer treatment appointments, and ancillary appointments, and assisting patients in an office or practice setting. You may be responsible for scheduling a high volume of complicated patient procedures and clinic appointments. You will serve as a liaison and information resources for physicians, nursing support staff, and coworkers, referring physician offices, patients and insurance companies on referral requirements per diagnosis and service. This role will be required to answer incoming calls to the clinic, to schedule, transfer, or triage to a clinical team. This role will explain detailed complicated procedures to patients and answer any patient questions or concerns within scope. Works closely with other medicine/surgery clinics for appointment coordination. Works reschedule and wait lists when necessary; Prepare and mail, fax, or email new patient information packets when necessary; Direct patients to appropriate providers for other health care issues; Complete and route direct referrals to other clinical services; Enter patient information accurately into the electronic medical record when necessary.
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.
Additional Business Functions/Duties / Coordination/Staff Resource:
- When called upon to do so, shares business expertise and disseminates business and clinical information to PAS Specialists within the Department.
- Instruct co-workers as needed in Epic.
- Maintains a service-based working knowledge of diagnostic and procedural coding.
- Provides on the job training, orientation, guidance and coaching for new PAS personnel in the service area.
Call Processing:
- As needed, responsible for connecting the patient with the appropriate individual to progress their care in the clinic; Transfers calls as needed, creates telephone encounters, contacts nursing coordinators, and pages providers and staff as needed per circumstance; Scheduling and managing of patient access to Center for Hematologic Malignancies Clinic; Create telephone calls from patients in the EMR which will include accurate documentation of requests for medication refills, complaints, general information 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); As needed, expected to take 10% of incoming volume of clinic calls.
Check-in/Checkout:
- Checks in and out clinic, procedure, and infusion appointments.
- This includes, but is not limited to careful review of insurance benefits, demographic information, confirming insurance eligibility, and /or authorization, and complex provider and infusion scheduling.
- Checks patient account numbers and corrects any problems, seeking advice from Central Registration as required.
- Ensures that all appointment comment information is accurate and completed.
- Identifies and updates deductible payments, co-payments, and prepayment requirements.
- Proper use of OHSU forms and documentation required for all patients.
Scheduling:
- Coordinate high volume of complicated patient care appointments, procedures, and infusion treatments 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 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 the electronic medical record when necessary. Maintains a service-based working knowledge of oncology practice.
- Is responsible for verifying patient eligibility and securing referral/authorization prior to the outpatient appointment or inpatient admission.
- The authorization process includes, but is not limited to, putting referral information on-line, obtaining authorization to provide care from the insurance company, identifying how much of the patient’s deductible has been met, determining how much of an education benefit has been exhausted, tracking the number of visits used per authorized, following up on referrals for return appointments, and other miscellaneous tasks.
- Obtains managed care authorizations for all consultations, procedures, office visits, and care arrangements by scheduling appointments and contacting other ancillary and clinical services as needed. Applies problem solving and negotiating skills in resolving patient concerns and managed care related problems.
Integrated Care:
- Obtain prior medical records and studies when appropriate; Responsible for obtaining, recording, tracking, and verifying referrals and authorizations for the respective outpatient clinic and lab visits when necessary.
Administrative Duties:
- Faxing; Letter queues; Use right fax to send outgoing fax notification re: referral receipt; Other duties as assigned.
Experience:
- 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. 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.
Job Related Knowledge, Skills and Abilities (Competencies):
- 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.
- Appointment scheduling experience.
- Basic computer keyboarding skills including typing of 40-50wpm.
- Proficient computer skills including word processing.
- Extremely high level of attention to detail.
- Strong customer service orientation.
- Must have excellent verbal and written communication, listening skills and awareness of self.
- Demonstrated reliable attendance record. Demonstrated effectiveness in confrontational customer interactions.
- 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.
- Must be able to perform the essential functions of the position with or without accommodation
- HS Diploma or advanced degree preferred
- Experience in a medical and/or oncology office setting.
- Knowledge of Epic systems.
- Knowledge of OHSU network systems, including Outlook and Microsoft Office products.
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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