Managed Care Coordinator

The Managed Care Coordinator (MCC) at Richmond Family Medicine Clinic is responsible for handling all aspects of the authorization process. The MCC processes incoming and outgoing department referrals along with prior authorizations for diagnostic services. This will include gathering appropriate and correct patient demographics financial information chart notes and other supporting documentation and confirming correct health coverage.

• Manages referral work queues and processes - communication scheduling and prior authorization - for LARC OB and specialty clinic appointments. Is responsible for verifying patient eligibility and securing referral/authorization prior to the outpatient appointment. The authorization process includes but is not limited to putting the referrals information on-line following up on referrals for return appointments and other miscellaneous tasks. This task includes management of the referral process from start to finish meeting or exceeding the appropriate service standards. Gathers and/or verifies patient information including demographics insurance coverage and financial status. Confirms patient eligibility for health care coverage. Obtains prior authorizations for clinical care procedures and diagnostic studies as appropriate. Enters all information accurately into Epic. Follows up on pending authorizations until they are obtained. Updates referral work queue.
• Maintains current information on all managed care insurance plans and is up-to-date with all managed care insurance plan changes utilizing information to efficiently and effectively obtain authorizations.
• Serves as a liaison and information source for other department support staff department physicians and referring providers/offices OHSU Health Plan Office patients and insurance companies for authorization requirements per diagnosis and service type. Provides back-up support for referral coordinators.
• Fills in as needed for any business position within the service areas including but not limited to template building and maintenance. Maintains a service based working knowledge of diagnostic and procedural coding.
• Communicates with patients/families other health care team members in a time and cost efficient courteous manner. Demonstrates active listening skills and supportive professional behavior at all times to patients families and staff. Documents all care given observations and patient response to care accurately and legibly in English in the medical record.
• Back up for answering phones and scheduling appointments as necessary; additional coverage for front desk duties as needed.

• 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 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 verbal and written communications skills. Strong customer service orientation. Demonstrated effectiveness in confrontational customer interactions.

• High school diploma or equivalent.
• Previous Epic experience.

• Exposure to ill patients - flu colds virus. Must be able to sit for long periods move about the clinic as necessary and use telephone and computer for extended periods of time.