Key Responsibilities & Performance Standards

Customer service:

• Provides high quality customer service to both external customers (patient, referring providers, and insurance carriers) and internal customers (OHSU health care providers and staff) that meets or exceeds 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. Answering phones. Help set up MyChart.

Enrollment & Authorizations:

• Gathers and/or verifies patient information including demographics, insurance coverage, and financial status. Confirms patient eligibility for health care coverage and clarifies any managed care arrangements. Obtains authorizations for clinical care, procedures, and laboratory studies. Enters all information accurately into OHSU databases or into the medical record when necessary. Follows up on pending authorizations until they are obtained

Arranged care:

• Schedules new patient appointments on line, and manually if necessary. Obtains prior medical records and studies if appropriate. Creates a medical record, scan medical records. Arranges stretchers, wheelchairs, and interpreters when necessary, and accommodates other special needs whenever possible (escorting patient to L&D). Mails information packets. Provides personal reminders to patients about upcoming appointments. Obtains and prepares OHSU medical records before scheduled appointments. Inpatient transportation set up, Specimen transportation.

Point of Service:

• Greets patients and confirms that an appointment has been kept. Inspects insurance cards and/or authorization notices. Identifies and collects deductible payments, co-payments, and deposits on services; provides receipts and completes necessary accounting procedures including reconciliation and deposit of funds. Verifies and updates the common data set on-line. Explains and satisfies any necessary patient signature requirements. Validates parking.
• Check in and check out. Checking MCMC scans prior to 8am. Processing Epic in-baskets.

Integrated Care:

• Arranges and orders associated clinical, diagnostic, or laboratory services; obtains authorizations when necessary. Directs patients to appropriate providers for other health care issues. Completes and routes direct referrals to other clinical services. Contacts primary care physicians or their designees to obtain authorizations for urgent care. Schedules return appointments on line, and manually if necessary; initiates authorization requests for subsequent care. Coordinates OOB requests for MFM and US (including process such as KCL and Amino and CVS). Back up to fetal therapy coordinator as needed (PTO/Sick calls). Coordination of fetal echo, maternal echo and MRIs. Coordination of care with Diabetes and Pregnancy Program (DAPP), MFM Cards, HMC, Salem, PHSW, MCMC, Warm Springs & Adventist

Telecommunications:

• Triages and documents accurately telephone calls from patients including requests for medication refills, complaints, general information inquiries, and urgent health care concerns. Delivers such information or requests promptly to the appropriate providers or their designees. Answering phones

Training and Competency:

• Successfully completes the required PAS initial training and core competency assessment before or during the trial service period. Completes all required update modules. Maintain core competencies, and demonstrate continuous application of these skills throughout the period of employment

Clinical Service Resource:

• Shares PAS expertise and disseminates PAS information to PAS Specialists within the service area. Instructs co-workers as needed in user skills for PAS system software including RSS, Order Entry, LCR, EAD, and the Minimal and Common data sets. Maintains a service-based working knowledge of diagnostic and procedural coding. Fills in as needed for any subordinate PAS position within the service areas. Including adding time holds for US orders/scheduling. Checks in MCMC scans prior to 8am.

Personnel Operations:

• Gives instruction for other PAS personnel pertaining to PAS processes and procedures as well as performance. Provides on the job training, orientation, guidance and coaching for new PAS personnel in the service area. May be required to distribute PAS duties within a defined work-group and to review work for conformance to standards. May be required to provide informational assessment of other PAS workers’ performance to the PAS Coordinator/Supervisor and/or the employment supervisor.

Managed Care Coordination:

• Maintains current information on managed care insurance plans and serves as a liaison and information resources for physicians, nursing support staff, and coworkers, referring physician offices, OHSU Health Plan, patients, and insurance companies on authorization requirements per diagnosis and service. Serves as service area expert on ICD9 coding requirements and issues. 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. Referral scheduling and processing (MFM, GC, HMC, HMH cards, FMU, Radiology and back up to fetal therapy; process faxes and Epic in-baskets. Submit referrals to external physician’s offices.

Office duties:

• Facility work orders (light burned out, etc.), submit supply orders to CWH admin coordinator, order patient questionnaires from copy center

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.

Busy environment with may interruptions, multiple demands and interactions. Handle high volume of patient phones calls, high level of multitasking. Be able to sit for long periods of time.