Managed Care Coordinator at Tualatin, OR – Tualatin, Oregon

Key Responsibilities & Performance Standards

• Verifies insurance eligibility and obtains benefits, referrals/prior authorizations and documents in patient’s file. Updates insurance information on patient’s accounts when applicable.
• Uses Epic Work-queues and schedules to obtain authorizations for ancillary service referrals and documentation of such.
• Reviews orders and documents treatment approvals and locations in patient’s record (EMR). Monitors all treatment regimens for insurance coverage and appropriateness of indication and forwards to Manager/Formulary Committee for approval as needed.
• Functions as a “point of inquiry” and resource for all work unit staff with questions regarding insurance coverage and where scans and treatments may be done.
• Applies problem solving and negotiating skills in working with insurance companies and referring providers to obtain a successful outcome.
• Performs financial counseling with patients prior to treatment and calculates co-insurance amounts as requested or obtains costs of treatment for ABN preparation.
• Reviews additions to the schedule of same day and next day appointments from outside OHSU providers for insurance and authorizations of medications to infuse in the day treatment clinic.
• Performs research and processes paperwork for financial assistance foundations to help patients pay for specialty drugs.

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.

• High School Diploma or GED
• Associate Degree or higher; minimally some college coursework in related field
• Knowledge of computer applications including Epic Cadence, and EARL