Key Responsibilities & Performance Standards

OR surgery scheduling/care coordination for SOR, CHH, DCH

• Receive surgery requests (Consult to OR) via Epic work queues
• Schedule pre-op/post-op, Pre-Medicine Clinic and pre-surgery COVID test appointments
• Communicate surgery logistics to patients via phone/MyChart
• Submit surgery case to OR scheduling department via Epic
• Monitor SOR, CHH and DCH grids to maintain accurate, up-to-date Outlook calendars for each department
• Notify external vendors and OR schedulers to ensure that all necessary equipment is availability
• Coordinate with OHSU co-surgeons and their practice surgery schedulers and other internal and external care providers/departments as needed for medical clearance prior to surgery and postoperative care following surgery
• Communicate and coordinate with CWH/OHSU social workers, caregivers, residential facility staff, etc. to arrange for medical transportation to surgery and related appointments and ensure appropriate lodging/RPV accommodations have been made
• Ensure that the appropriate medical orders are in place for surgery-related care (imaging, lab work, referrals, etc.)
• Ensure that all medical records are in place as requested by surgeon and obtain medical records, as needed
• Document all information and/or any surgery-specific changes/updates in Consult to OR referral notes
• Educate and communicate with patient and clinic staff regarding current CWH and OHSU policies related to surgery
• Manage, release, and transfer OR blocks and add-on requests via iQueue and Epic
• Apply problem solving and negotiating skills in resolving provider and patient concerns and other surgery related problems

Managed care for surgical cases:

• Complete insurance benefit checks for each surgery case
• Maintain working knowledge of diagnostic and procedural coding appropriate for the service area to provide accurate CPT and ICD-10 codes for benefit checks and prior authorization requests
• Maintain working knowledge of Oregon Health Authority Prioritized List and Medicare Inpatient Only List
• Obtain prior authorizations, as needed, by providing relevant clinical documentation and communicating with insurance companies for any follow-up information and status updates
• Communicate all necessary insurance and/or payment information to patients prior to moderate sedation, self-pay and/or flat-fee cases, and any other surgery cases, as needed
• Communicate with referring providers, primary care providers and/or co-surgeons, as needed, for insurance authorization purposes
• Investigate and process appeal requests for insurance prior authorization denials, coordinate peer-to-peer phone calls, obtain surgeon letters of medical necessity, additional medical records as requested by insurance companies and educate patients and surgeons on appeals process
• Submit cost estimate requests to Patient Estimates Department, upon request
• Enroll patients in RH program, as needed
• Investigate surgery claim denials from No-Auth Work Queue and process claim appeals, as needed
• Initiate OHSU Financial Assistance exception requests on patient’s behalf, as needed
• Educate patients, clinic staff and surgeons regarding insurance coverage, payment information, prior authorization and appeals processes

Moderate sedation case scheduling and managed care:

• Receive moderate sedation case requests (Consult to OR) via Epic work queues
• Communicate with CWH care coordinators to ensure that patients are scheduled appropriately
• Manage/update Moderate Sedation Outlook calendar with scheduling changes
• Complete benefit checks and obtain prior authorizations, as needed
• Provide cost estimate statements and/or payment information to patients upon request

L&D scheduling and managed care

• Receive surgery requests (Consult to OR) via Epic work queues
• Schedule elective induction of labor, cesarean sections, cesarean-hysterectomy, cerclage placements, cephalic versions in L&D
• Complete benefit checks and obtain prior authorizations, as needed
• Monitor L&D and SOR grids to maintain accurate, up-to-date Outlook calendars
• Schedule stress tests

Fetal department surgery scheduling and managed care:

• Receive surgery requests (Consult to OR) via Epic work queues
• Monitor L&D and SOR grids to maintain accurate, up-to-date Outlook calendars
• Complete benefit checks and obtain prior authorizations for fetal echo appointments, genetic testing and other fetal related appointments, as needed
• Investigate and process denial for fetal office visits

Other Duties:

• Back up other Surgery Schedulers.
• Maintain outlook calendar and OR blocks.
• Provide Surgery Scheduling Orientation/Education to the Residents.
• Other duties as assigned by manager.

• High School Diploma
• 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
• Advanced PAS user skills as well as extensive knowledge of integrated care at OHSU
• Two years of experience working Managed Care in a clinic/hospital setting.
• Two years of experience working as a Surgery Scheduler for multiple Providers.
• One-year experience working in Women’s Health.
• Extremely organized and meticulously detailed.