PAS Revenue Cycle Specialist

Patient Access Services Department OverviewTo support Oregon Health Sciences University's mission by providing exemplary service to all patients, patient families, visitors, and staff who present to any area of Patient Access Services Department in person, via telephone, or over electronic communication. To greet, interview, register, and pre-register patients scheduled for hospital admission. Creates reservations for day patient and Inpatient admissions and complete Inter-Hospital transfers. Obtains and records demographic and insurance data to ensure accurate patient identification to facilitate payment and compliance with all regulatory requirements. Performs employee requirements as outlined in Compliance Roles and Responsibilities, Code of Conduct and Respect at the University for OHSU Hospital and Clinics.Function/Duties of PositionCustomer ServiceProvides high quality customer service to both external and internal customers that meets or exceeds the service standards of the health care industry.Promptly greet all patients, visitors, and others in a warm, courteous, and professional manner, face to face or over the phone.Demonstrates the ability to communicate effectively, timely, and respectfully at all times, especially in a high stress environment.Provides flexible coverage to assist with internal service needs and the continuous application of process improvement methods and skills.As problems and miscommunications occur with internal or external customers, demonstrates the ability to clarify and resolve problems immediately to avoid further communication breakdowns.Demonstrates knowledge of all department locations, units, and buildings on OHSU Campus.Answers multi-line telephone inquiries. Determine caller needs and assist callers efficiently and appropriately.Determine priorities and act quickly, make decisions efficiently and in a calm manner in emergency and stressful situations.Facilitating after hours foot traffic into OHSU hospital. This includes providing directions and screening of all patients and visitors.Liaison between clinical team, social work and case management for complicated patients and family members.Utilizes appropriate interpreter services when necessary.Patient Registration/InterviewsGathers, adds, updates, and/or verifies detailed demographic information and completed/signed forms required for services. These functions are performed at stationary computer terminals or at patient's bedside using a mobile computer terminal, occasionally over the phone. Hand written documentation may only be utilized during computer downtime or device malfunction.Completes Race, Ethnicity, Language, and Disability (REALD) questionnaire with patient face to face or over the phone and updates REALD Smart Form as required by law. Serves as liaison for patients and families with questions.Satisfies state regulations to identify support persons for individuals with disabilities.Correctly identifies patient service type to establish an accurate and billable account.Schedules reservations into Epic with a base knowledge of diagnoses and procedures.Accurately complete Inter-Hospital Transfers and same-day admissions and obtain prior medical records as needed.Activates direct admissions based on notification from unit at time of patient's arrival.Follows Oregon Administrative Rules (OAR's) regarding workers' compensation in operation of OHSU and industry workman's compensation procedures. Provides timely follow up for completion of workman's compensation "827" and DOLI form for work related injuries.Initiates and completes claims for worker's compensation injuries, personal injury, motor vehicle accidents, and crime victim accounts.Provides patient education regarding OHSU financial assistance, insurance coordination of benefits, Patient Rights, Terms & Conditions, Advance Directives, Medicare Secondary Payer Questionnaire, Medicare and Commercial notices of Non-Covered services (ABN or NCCF), Important Message from Medicare, Release of Information, Special Consent, Champus Message to patients and their representatives, Notice of Privacy Practices, use of patient information and/or specimens in OHSU research, and other facility or regulatory documents.Responsible for all identity management corrections after hours.Identifies and collects co-pays, deductible payments, deposits, and prepayments for services as required.Provides receipts and completes necessary accounting procedures including reconciliation and deposit of funds.Creates and assembles Patient Packets as required for Hospital @ Home or other admitting areas.Determines urgent/emergent medical situations and activates rapid response team or engages the assistance of nursing staff to assist.Insurance Verification/Financial ClearanceGathers, adds, updates, and/or verifies detailed insurance coverage and financial status with each patient over the phone or face to face.Creates new and maintains existing insurance coverages/guarantors for a patient based on their insurances and the care being provided.Obtains benefit information including deductible or co-pays, co-insurance, stoploss or out of pocket status, and correct billing address.Complete insurance verification on each patient's insurance 100% of the time when the insurance verification status says New, Elapsed, Incomplete, Needs Review, or is Medicaid, using electronic verification in RTE, payer portals, or other required methods. The PAS Revenue Cycle Specialist staff will also re-verify the eligibility insurance information if the insurance was not verified in the current month.Reviews MMIS for all uninsured or single coverage patientsRefers all non-sponsored patients to Oregon Health Plan (OHP) and provides information for financial assistance, working closely with Financial and Medicaid Services.Ensures all required forms are completed for services and confirmation of payment sources.As required, notifies payors of admissions to OHSU Facilities for patients that are treated in the Emergency Department, facility-to-facility transfers for higher level of care, or direct admissions.Maintains current information on managed care insurance plans and serves as a liaison and information resource for patients, referring physician offices, and other OHSU staff. Applies problem solving and negotiating skills in resolving patient concerns and managed care related issues.Maintains knowledge pertaining to insurance issues which includes but is limited to motor vehicle, workman's compensation, personal injuries, Medicare, OHP/Washington Welfare/Medicaid, and exposures.Collects detailed information of trauma admissions (motor vehicle accident, personal injury, and/or worker's compensation) to determine accident-related liability.Other duties as assigned.Required QualificationsHigh School diploma or equivalent.One year of experience in a medical office setting, including high-volume direct patient contact, scheduling of appointments and registration and/or billing responsibilities. ORTwo years of work experience in a high-volume direct public contact, front-line non-healthcare setting position.Knowledge, Skills, and AbilitiesBasic computer skills including word processing and Windows applications.Basic computer keyboarding skills including typing of minimum 40 wpm.Demonstrated working knowledge around insurances and benefits.Demonstrated excellent verbal and written communications skills.Strong customer service orientation.Demonstrated effectiveness during extremely confrontational customer interactions in a high stress environment.Demonstrated advanced PAS user skills or equivalent as well as extensive knowledge of integrated care models.Ability to walk and stand for 6-8 hours per day, position is extremely mobile.Preferred QualificationsPrior experience in hospital admissions or ED registration.Minimum six months experience as a registrar at OHSU and demonstrated accuracy rate of 97% or greater. As a registrar, must be meeting/exceeding all other individual performance standards in a sustained manner.Thorough knowledge of verifying medical insurance, including worker's comp and third party liability.OHSU Registration experience.Demonstrated efficiency and problem solving in resolving patient concerns.Strong attention to detail and processes.Ability to work with a high level of accuracy, speed, multitask, and prioritize in high stress/high volume environments, with little direct supervision.Demonstrated effective interpersonal skills, which promote cooperation and team