Oregon Health & Science University
Managed Care Coordinator/Insurance Verification & Patient Estimates Specialist (
Oregon Health & Science University, Portland, Oregon, United States, 97204
Department Overview
This position is responsible for managed care, insurance verification and patient price estimate processes within the Centralized Managed Care & Price Estimates (CMC) department. It supports the OHSU systems and operations of ambulatory practices, professional services and hospital departments. The coordinator works closely with internal and external customers including Intake Coordinators, Clinical Staff, Surgery Schedulers, Care Managers, Financial Counselors, Insurance Companies, PCP Office Staff, and CMC Leadership to ensure patients receive optimal financial services related to their care. The Managed Care Coordinator and Insurance Verification & Patient Estimates Specialist provide clear and accurate information regarding patients, financial obligations related to their visits, treatments, procedures, and/or hospital admissions. Responsibilities include obtaining and/or verifying prior authorizations, verifying benefits, creating cost estimates, contacting patients to provide estimates, offering pre‑service payment opportunities, and collecting pre‑service payments for visits, treatments, procedures, and/or hospital admissions. The role also provides guidance for other staff regarding patient liabilities, health care contract terms, complex patient referrals, and other managed care issues. The incumbent possesses extensive knowledge of managed care and insurance verification processes in both ambulatory and inpatient settings, including insurance eligibility, benefits verification, and authorization requirements. They are proficient with the Epic system and current best‑practice referral and prior authorization workflows, serving as backup to the Centralized Managed Care & Price Estimates Department as needed for cross‑coverage of all managed care and insurance verification workflows.
Function/Duties of Position
Review incoming referral orders to assess patient needs based on diagnosis, insurance coverage, or lack thereof, and previous treatments. Referrals may be received internally via Epic or externally via fax or other methods.
Verify patient information including demographics, insurance coverage and financial status. Confirm patient eligibility for health care coverage and clarify managed care arrangements. Document details related to liability insurance (e.g., motor vehicle accident, personal injury, or worker’s compensation) to determine third‑party liability.
Obtain benefit information including current eligibility, deductible or co‑pays, co‑insurance, stop‑loss or out‑of‑pocket status, authorization requirements, PCP referral requirements, days approved for routine admissions, and correct billing address.
Document information based on department protocols in the Epic Referral shell.
Work closely with referring providers to obtain necessary insurance referrals and authorizations.
For urgent/emergent admissions, provide admit information and set up authorizations and/or PCP referrals. Contact care‑management to obtain clinical review and length of stay.
For routine admissions, confirm that authorizations and/or PCP referrals cover the designated admission. If not noted, contact the Managed Care Coordinator from the specialist’s office to follow up with the designated insurance company.
Obtain authorizations for all clinical care, procedures, diagnostic studies, medications, outpatient infusion treatment, and inpatient admissions, including notifying insurance upon admission.
Follow up on all pending authorizations and/or PCP referrals until accounts are secured.
Maintain current information on managed care insurance plans and serve as a liaison and information resource for patients, referring physician offices, and other OHSU staff. Apply problem‑solving and negotiating skills to resolve patient concerns and managed care related issues.
Appropriately code insurance plans in EPIC for billing purposes.
Work directly with insurance companies, the denial coordinator, and clinical staff and/or providers to supply necessary information for appealing denied claims and/or authorization requests as applicable.
Provide backup support for other Managed Care coordinators within the Centralized Managed Care & Price Estimates department.
For self‑pay patients, complete duties associated with financial assistance determinations such as above/below the line, including connecting patients with necessary social work or financial counseling.
Complete necessary forms prior to upcoming procedures, admissions, and/or appointments (e.g., Non‑Covered Charges Form (NCCF), Advanced Beneficiary Notification (ABN), or Patient Financial Estimate (FE)) as required.
Work directly with patients and the clinical team to ensure patients are knowledgeable and understand their insurance benefits and/or financial obligations.
Patient Liability Estimates
Review work queue for patients that need an estimate created.
Document information based on department protocols in the Epic referral shell.
Create a Patient Liability Estimate.
Complete accurate pre‑registration via phone as applicable.
Contact the patient prior to service to inform them of their estimate and collect any pre‑payments at that time.
Other duties as assigned. Required Qualifications Experience:
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). One and a half years of work experience in a high‑volume direct public contact position and six months experience in a medical office setting.
Knowledge, Skills, and Abilities:
Thorough knowledge of PAS policies and procedures; advanced PAS user skills; extensive knowledge of integrated care at OHSU. Knowledge of managed care policies and procedures, authorization and referral processes in EPIC. Proficiency in verifying medical insurance, including worker’s compensation and third‑party liability. Basic computer skills, including MS Word, Excel, Access, and OHSU Epic skills, plus online resource use. Excellent written and verbal communication skills. Demonstrated knowledge of managed care and insurance verification policies and procedures with appropriate timelines, paperwork, regulations, communication and follow‑up. Demonstrated efficiency, problem‑solving and negotiation skills in resolving patient concerns and insurance related problems. Ability to multitask in a high‑volume situation. Strong attention to detail and processes. Ability to work autonomously with high accuracy, speed, and willingness to meet deadlines. Strong customer service orientation and effectiveness in confrontational customer interactions.
Preferred Qualifications High School Diploma or GED. Excel skills and knowledge preferred.
Additional Details Work Schedule: Monday‑Friday, 8‑hour shift during operational hours 7:00 am‑5:30 pm. Work location: Downtown Portland (Fifth Avenue Building)/Teleworking. All are welcome. Oregon Health & Science University values a diverse and culturally competent workforce. We are proud of our commitment to being an equal‑opportunity, affirmative action organization that does not discriminate against applicants on the basis of any protected class status, including disability status and protected veteran status. Individuals with diverse backgrounds and those who promote diversity and a culture of inclusion are encouraged to apply. To request reasonable accommodation, contact the Affirmative Action and Equal Opportunity Department at 503‑494‑5148 or aaeo@ohsu.edu.
#J-18808-Ljbffr
Function/Duties of Position
Review incoming referral orders to assess patient needs based on diagnosis, insurance coverage, or lack thereof, and previous treatments. Referrals may be received internally via Epic or externally via fax or other methods.
Verify patient information including demographics, insurance coverage and financial status. Confirm patient eligibility for health care coverage and clarify managed care arrangements. Document details related to liability insurance (e.g., motor vehicle accident, personal injury, or worker’s compensation) to determine third‑party liability.
Obtain benefit information including current eligibility, deductible or co‑pays, co‑insurance, stop‑loss or out‑of‑pocket status, authorization requirements, PCP referral requirements, days approved for routine admissions, and correct billing address.
Document information based on department protocols in the Epic Referral shell.
Work closely with referring providers to obtain necessary insurance referrals and authorizations.
For urgent/emergent admissions, provide admit information and set up authorizations and/or PCP referrals. Contact care‑management to obtain clinical review and length of stay.
For routine admissions, confirm that authorizations and/or PCP referrals cover the designated admission. If not noted, contact the Managed Care Coordinator from the specialist’s office to follow up with the designated insurance company.
Obtain authorizations for all clinical care, procedures, diagnostic studies, medications, outpatient infusion treatment, and inpatient admissions, including notifying insurance upon admission.
Follow up on all pending authorizations and/or PCP referrals until accounts are secured.
Maintain current information on managed care insurance plans and serve as a liaison and information resource for patients, referring physician offices, and other OHSU staff. Apply problem‑solving and negotiating skills to resolve patient concerns and managed care related issues.
Appropriately code insurance plans in EPIC for billing purposes.
Work directly with insurance companies, the denial coordinator, and clinical staff and/or providers to supply necessary information for appealing denied claims and/or authorization requests as applicable.
Provide backup support for other Managed Care coordinators within the Centralized Managed Care & Price Estimates department.
For self‑pay patients, complete duties associated with financial assistance determinations such as above/below the line, including connecting patients with necessary social work or financial counseling.
Complete necessary forms prior to upcoming procedures, admissions, and/or appointments (e.g., Non‑Covered Charges Form (NCCF), Advanced Beneficiary Notification (ABN), or Patient Financial Estimate (FE)) as required.
Work directly with patients and the clinical team to ensure patients are knowledgeable and understand their insurance benefits and/or financial obligations.
Patient Liability Estimates
Review work queue for patients that need an estimate created.
Document information based on department protocols in the Epic referral shell.
Create a Patient Liability Estimate.
Complete accurate pre‑registration via phone as applicable.
Contact the patient prior to service to inform them of their estimate and collect any pre‑payments at that time.
Other duties as assigned. Required Qualifications Experience:
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). One and a half years of work experience in a high‑volume direct public contact position and six months experience in a medical office setting.
Knowledge, Skills, and Abilities:
Thorough knowledge of PAS policies and procedures; advanced PAS user skills; extensive knowledge of integrated care at OHSU. Knowledge of managed care policies and procedures, authorization and referral processes in EPIC. Proficiency in verifying medical insurance, including worker’s compensation and third‑party liability. Basic computer skills, including MS Word, Excel, Access, and OHSU Epic skills, plus online resource use. Excellent written and verbal communication skills. Demonstrated knowledge of managed care and insurance verification policies and procedures with appropriate timelines, paperwork, regulations, communication and follow‑up. Demonstrated efficiency, problem‑solving and negotiation skills in resolving patient concerns and insurance related problems. Ability to multitask in a high‑volume situation. Strong attention to detail and processes. Ability to work autonomously with high accuracy, speed, and willingness to meet deadlines. Strong customer service orientation and effectiveness in confrontational customer interactions.
Preferred Qualifications High School Diploma or GED. Excel skills and knowledge preferred.
Additional Details Work Schedule: Monday‑Friday, 8‑hour shift during operational hours 7:00 am‑5:30 pm. Work location: Downtown Portland (Fifth Avenue Building)/Teleworking. All are welcome. Oregon Health & Science University values a diverse and culturally competent workforce. We are proud of our commitment to being an equal‑opportunity, affirmative action organization that does not discriminate against applicants on the basis of any protected class status, including disability status and protected veteran status. Individuals with diverse backgrounds and those who promote diversity and a culture of inclusion are encouraged to apply. To request reasonable accommodation, contact the Affirmative Action and Equal Opportunity Department at 503‑494‑5148 or aaeo@ohsu.edu.
#J-18808-Ljbffr