Providence Health & Services Medical Management Coordinator in Portland, Oregon
Providence is calling a Medical Management Coordinator (1.0 FTE, Days) to Providence Office Park in Portland, OR.
In this position, you will:
Be responsible for the implementation of policies and procedures relating to aspects of the Medical Management Program and Work plan of Providence Physicians Division (PPD) and performs duties supporting the core functional areas of: specialist referral processing, prior authorization, diagnostic imaging scheduling, physician call triaging, appeals, auditing and training.
Focus on the technical support and the organization/coordination of support activities such as: production, program outcomes against stated policies, standards and objectives; and the development of training and documentation for process and performance improvement activities relevant to the Medical Management Program.
Assure an integrated approach to the program is fulfilled, resulting in timely scheduling of requested services, communication across the continuum of care for requested outpatient services resulting in improvement in the provision of care and services and improved satisfaction for our patients, providers, staff and external contacts.
Function in a team environment, providing requested services in a centralized setting on behalf of the PPD clinics.
Servce as an expert resource to PPD providers, specialists and staff in regard to the specialist referral / prior authorization requirements for multiple contracted and non-contracted insurance plans, diagnostic imaging protocols which vary between the multiple facilities/sites providing this service, and processes relating to these functions.
Be the liaison between PPD physicians, patients, multiple Providence Health System Diagnostic Imaging scheduling and modality (e.g., CT, MRI, Nuclear Medicine) departments, freestanding diagnostic imaging centers and the contracted insurance plans. In addition to specialist referral processing, this position also facilitates prior-authorization for selected procedures as directed by the patients’ insurance.
Required qualifications for this position include:
High school diploma or equivalent
Current state registration, license, or certification as appropriate to education.
Working knowledge and/or experience in a utilization management functional area such as prior authorization, medical audit, appeals or delegation is highly preferred (3-5 years in related field).
Knowledge of coding, medical terminology, insurance billing, claims and managed care principles.
Excellent verbal communication, negotiation and interpersonal skills.
Preferred qualifications for this position include:
Undergraduate degree -or- equivalent work experience in a medical clinic or managed care/health insurance plan (3-5 years in a related field).
Certified Medical Assistant (CMA) or Medical Assistant (MA) with clinical experience working in clinic setting
2 years in a business environment
About Providence in Oregon
As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.
The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple,
"Providence will provide the best care and service to every person, every time."
Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.
We offer a full comprehensive range of benefits - see our website for details
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Administrative (Clinical)
Req ID: 233191