Care Coordinator

• Review incoming referral orders to assess patient needs based on diagnosis, insurance coverage or lack thereof, and previous treatments
• Verify patient demographics, insurance coverage, financial status and eligibility
• Clarify managed care arrangements and document third-party liability information
• Obtain benefit information including deductibles, copays, coinsurance, out-of-pocket status, authorization and PCP referral requirements, approved days, and billing address
• Document information in the Epic Referral shell according to department protocols
• Work with referring providers to obtain insurance referrals and authorizations
• Provide admit information and arrange authorizations or PCP referrals for urgent/emergent admissions
• Confirm authorizations and PCP referrals for routine admissions
• Notify insurance companies upon admission when appropriate
• Obtain authorizations for clinical care, procedures, diagnostic studies, medications, outpatient infusion treatment and inpatient admissions
• Follow up on pending authorizations and PCP referrals until accounts are secured
• Maintain current managed care insurance plan information and serve as a liaison for patients, physician offices and OHSU staff
• Resolve patient concerns and managed care issues using problem-solving and negotiation skills
• Collect trauma admission information to determine accident-related liability
• Code insurance plans appropriately in Epic for billing purposes
• Support denied-claim and authorization-request appeals by providing necessary information
• Provide backup support for other Managed Care Coordinators
• Complete financial assistance determination duties for self-pay patients and connect them with social work or financial counseling
• Complete required forms such as NCCF, ABN and Patient Financial Estimate forms
• Review work queues for patients needing estimates
• Create Patient Liability Estimates
• Complete pre-registration by phone as applicable
• Contact patients before service to explain estimates and collect pre-payments
• Perform other duties as assigned

Care Coordinator jobs in Oregon

Managed Care Coordinator – PAS Resource Specialist