Managed Care Coordinator (PAS Resource Specialist)

Oregon Health & Science University; Portland (OR); On-site; USD 40,000 - 70,000; Full time

Job summary

An established industry player in healthcare is seeking a Managed Care Coordinator to oversee the authorization process in a vibrant community clinic. This role involves managing referrals, verifying patient information, and ensuring efficient processing of authorizations. With a focus on patient care, the coordinator will work closely with a team of dedicated professionals to support a diverse patient population. The position offers a dynamic work environment where your contributions directly impact patient experiences. If you are passionate about healthcare and thrive in a fast-paced setting, this opportunity is perfect for you.

Qualifications

• One year of experience in a medical office setting with high-volume patient contact.
• Thorough knowledge of PAS policies and procedures.

Responsibilities

• Manage referral work queues and verify patient eligibility.
• Gather and verify patient information, confirming insurance coverage.

Skills

Verbal Communication

Written Communication

Customer Service

Basic Computer Skills

Database Skills

Education

High School Diploma or Equivalent

Tools

Epic Software

Job description

Managed Care Coordinator (PAS Resource Specialist)

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Job Overview

Family Medicine at South Waterfront is a community-based clinic offering primary care and specialty services for all patients, including babies, children, adolescents, adults, and seniors. Services include maternity care, women's reproductive health, behavioral health, transgender care, pediatric care, travel immunizations, podiatry, sports medicine, acupuncture, minor procedures, and preventive health maintenance. The clinic sees between 200 and 275 patients daily, supported by over 40 providers and 60 staff members.

Position Summary

The Managed Care Coordinator (MCC) manages all aspects of the authorization process, including handling referrals and prior authorizations for diagnostic services. Responsibilities include collecting accurate patient demographics, insurance information, chart notes, and supporting documentation, and verifying health coverage.

Key Responsibilities

1. Manage referral work queues, verify patient eligibility, and secure referrals/authorizations prior to appointments, ensuring timely and efficient processing.
2. Gather and verify patient information, confirm insurance coverage, obtain prior authorizations, and input data into Epic accurately. Follow up on pending authorizations and update work queues accordingly.
3. Provide backup support for answering phones, scheduling appointments, and front desk duties as needed.
4. Maintain current knowledge of managed care insurance plans and updates to facilitate efficient authorization processes.
5. Perform other related duties as assigned.

Minimum Qualifications

• One year of experience in a medical office setting with high-volume patient contact, including scheduling and managed care authorizations, OR
• One and a half years of experience in a high-volume public contact role plus six months in a medical office.
• Thorough knowledge of PAS policies and procedures.
• Extensive experience with PAS systems and integrated care at OHSU.

Skills and Knowledge

• Basic computer skills, including word processing and online scheduling; database skills preferred.
• Excellent verbal and written communication skills.
• Strong customer service orientation and ability to handle confrontational interactions effectively.

Preferred Qualifications

• High school diploma or equivalent.
• Experience with Epic software.

Additional Details

Exposure to ill patients (flu, colds, viruses). Must be able to sit for extended periods, move around the clinic as needed, and use telephone and computer extensively.