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Location

Beaverton, OR | United States

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Job description

***Available for Hybrid Work***

 

This position has direct responsibility for supervising managed care personnel and processes within Community Hematology Oncology (CHO), with the potential to extend to other departments or specialties in the future. CHO comprises five clinics and infusion suites located throughout the Portland-metro area. Of these, four are part of the OHSU Knight-Legacy Health Cancer Collaborative (Cancer Collaborative), a partnership between Legacy Health and OHSU. This partnership is aimed at enhancing hematology and oncology care delivery and accessibility across organizations and the broader community. The Managed Care Supervisor plays a pivotal role in overseeing managed care operations within this matrixed environment.

 

Managed care staff are responsible for the patient financial experience. This includes eligibility and benefit verification, obtaining prior authorization or verification of appropriate authorization, creating patient estimates, securing prepayment, among other duties.

 

This position will directly supervise 8 staff at CHO, with the potential for growth over time to include staff within both CHO and other departments/speciailites, and has oversight for the following:

 

• Eligibility and benefits verification
• Prior authorization (for all services including office visits, ancillary services, infusion services, and chemotherapy)
• Patient liability estimations and pre-collection
• Retroactive authorizations and appeals for denied services

 

The incumbent leads their team by recruiting, training, mentoring, and managing the work queues and performance of all direct reports, to ensure the department’s key performance indicators are met. The Managed Care Supervisor will also perform the duties of their staff as needed. This position will serve as the first line of communication with the practices/departments to answer questions, troubleshoot issues, and improve processes/workflows. This role reports directly to the Sr. Director, Cancer Collaborative, and also works in partnership with other OHSU and Cancer Collaborative leaders and stakeholders to achieve our shared goals of enhancing hematology and oncology care delivery and access for patients throughout our community.

Eligibility Verification, Prior Authorization:

• Ensures that each high-liability patient contact has a valid Epic referral attached to the appointment.
• Ensures any services requiring prior authorization are requested within appropriate timeframes. 

• Re-prioritizes resources when necessary to ensure metrics are met.
• Ensures all eligibility verification and pre-authorization information is documented accurately in the Epic referral or Auth/Cert.
• Reviews denials for lack of prior authorization to attempt to resolve the issue. Recommends changes to processes in order to improve denial rates.
• Addresses staff concerns and helps resolve at-risk accounts.
• Updates, revises, and creates processes and procedures. 
• Provides functional direction and overall monitoring of managed care and insurance verification activity by reviewing and analyzing reports and individual work lists.
• Regularly works with teams and vendors, providing feedback on identified issues.

Patient Estimates:

• Works on and reviews patient estimates as needed to ensure patients are provided accurate estimates for their scheduled visits and treatments.
• Involved in system changes and coordinates necessary training for staff.
• Monitors weekly and monthly collections completed by the team.
• Acts as a liaison for international and self-pay patients.
• Updates and coordinates patient estimate letters as needed.
• Works with financial counseling, social work, and other team members as needed regarding patient accounts.

Staff Development

• Ensures that each employee demonstrates competencies in the workflows they are responsible for.
• Provides cross-training opportunities to promote growth and team flexibility.
• Ensures staff receive training and development opportunities to more effectively manage their workloads.
• Maintain personnel files, ensuring staff are compliant with training, employee health or other requirements. 
• Conducts regular huddles and staff meetings, sets meeting agendas, and facilitates effective meetings
• In conjunction with leadership, identifies the developmental needs of staff, individually and department wide, coordinates training, and develops in-services to meet these needs.
• Create opportunities for staff to participate in planning, decision-making, and problem-solving.
• Engage regularly with direct reports, to include conducting STAY interviews and GROW performance discussions. Develop corrective action plans as needed.
• Assure all initial and ongoing training, orientation, staff meeting attendance, and in-service requirements are met. 

• Associate degree or combination of education and equivalent experience.
• Three years prior experience in a clinical setting working with patient scheduling, benefit verification, pre-authorization, and a high level of patient interaction. Experience should demonstrate progressive additions to responsibility and time spent serving as a lead worker.
• Healthcare revenue cycle experience. Incumbents must be familiar with Microsoft Office products. Candidate must have superb organizational skills and strong customer service orientation and experience. Must have the ability to work autonomously, be flexible, and able to shift priorities on short notice. The ideal candidate is driven by achieving outcomes in a timely manner.

• Bachelor’s Degree. Coursework in Healthcare and/or Education. 
• Specific experience with an integrated health record, Epic preferred. Experience with determining the acuity of patients for managed care purposes.
• Working knowledge of OHSU systems, policies, procedures, and the OHSU practices. Experience with supervising staff who perform managed care, scheduling, and patient estimation.

Although the position is expected to work standard Monday – Friday business hours, there may be times when availability is necessary on weekends and/or during the evening. Work Location: Remote with hotel (desk share) stations at the various CHO practice locations. Will occasionally be required to travel to the various CHO sites throughout the Portland-metro area, OHSU main campus, and OHSU waterfront, for meetings/training.

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 [email protected].

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Job tags

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Salary