• Job Description

  Req#: 21-10925
  Client Resource Specialist Onsite, possibility for Remote (must be local) No patient contact M-F 8-5 JOB SUMMARY: This position directly supports the practice by providing high quality customer service through prompt and professional communication on the phone and face-to-face, excellent problem solving skills and functioning as a team member to the other staff within our Pediatric Orthopedic Practice. The Client Resource Specialist schedules surgery, schedules clinic appointments and ancillary procedures and prepares clinic; makes appointment reminder calls; confirms and/or obtains prior approval referrals and authorizations for clinic visits, clinic procedures and surgeries; verifies insurance eligibility. This is a full time position. Regular attendance is a requirement for effective facilitation of patient care in Pediatric Orthopedics. Key Responsibilities & Performance Standards: 1. Provides high-quality customer service to both external customers (patients, referring providers, and insurance carriers) and internal customers 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 skills, facilitation with available information, technology, responsiveness to internal/external customers needs and requests, flexible coverage of internal services needs and the continuous process improvement methods and skills. Help investigate the nature of and solve communication problems between specialty offices and/or hospital. 2. 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 Office, patients, and insurance companies on authorization requirements per diagnosis and service. Serves as service area expert on ICD10 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 3. 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. Follows up on pending authorizations until they are obtained. Responsible for the charge review and follow up work queues to investigate missing information or denied claims. Assist with letters to appeal denied claims. 4. Schedules new and established patient appointments in EPIC. Obtains external images from diagnostic facilities for current patients when ordered by the provider and communicating with provider and families as to what the follow up plan is AFTER the image/ reports are review by the provider. Facilitates PT/ OT with families and insurances as well as external diagnostic imaging. Arranges ancillary appointments and interpreters when necessary, and accommodates other special needs whenever possible. Provides personal reminders by telephone to patients about upcoming appointments. Integrated Care. Arranges 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; initiates authorization requests for subsequent care. 5. Triages and documents accurately telephone calls from patients including requests for medication refills, complaints, general information inquiries, and urgent health care concerns into EPIC. Delivers such information or requests promptly to the appropriate providers or their designees through EPIC inbasket messages and telephone encounters. Template Provider clinics in Epic. 6. Shares Client expertise and disseminates Client information to new Client staff within the service area. Instructs co-workers as needed in user skills for Client system software including EPIC and its applications. Assists Pediatric Surgery providers with EPIC system questions. Maintains a service-based working knowledge of diagnostic and procedural coding. Fills in as needed for any subordinate or equal Client position within the service areas. 7. Schedules surgeries in EPIC. Maintains current information regarding surgery schedules for service site providers. Serves as liaison and information resource for physicians, nursing support staff, coworkers, IP Admitting Department, Surgery Office, and Periop Services. Collects from physician all information necessary to schedule a surgery (including ICD10 codes, equipment needs, etc.). Insures all equipment, vendors, neuromonitoring, and all other special surgical equipment requested is in place for surgeries. Obtains insurance authorizations. Facilitates care arrangements by scheduling pre-op appointments, PAT clinic, ancillary and clinical services as needed. Applies problem solving and negotiating skills in resolving provider and patient concerns and other surgery related problems. Provides personal reminders by telephone to patients about upcoming surgery appointments. REQUIRED: One year experience in a medical office setting including high-volume direct patient contact and scheduling of appointments and obtaining managed care authorizations. Must have a thorough knowledge of Client policies and procedures. Cadence scheduling experience required. Ability to prioritize tasks effectively; work well under pressure; be a self-starter; exercise common sense; ability to investigative and research a wide variety of topics highly useful; obtaining managed care authorizations. Job Classification Code: 0161A Fiscal Authority Approver: Ryan Chaquette Position Management Executive: Joe Ness Timecard Approver(s): Jennifer Andrews Backup Timecard Approver(s): Deena Dryden

• About the company

  ObjectWin provides global workforce solutions,ObjectWin,Workforce Solutions,IT Solutions,Staffing and Staffing Industry to meet current and future business demands of our customers.

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