The Centralized Managed Care Program Manager will focus on front end revenue cycle operations, which includes workflows for referrals, benefit verification, pre-authorization, denials for no authorization, patient estimates and front end cash collections.

The Centralized Managed Care Program Manager oversees projects that impact both the centralized and non-centralized managed care teams. In addition, he/she will support the non-centralized managed care teams to ensure they have the most up to date payor information and both initial and ongoing training. The Program Manager is also responsible for support OHSU partner initiatives as they relate to managed care. This includes but is not limited to Epic backload conversions, go-live support, managed care training, real time eligibility training, etc.

The Program Manager is knowledgeable in Lean and/or process improvement methodologies so he/she can represent Centralized Managed Care on related projects across the organization. S/He works closely with Department Administrators for centralized and non-centralized managed care initiatives as well as the Enterprise Revenue Cycle team to ensure positive outcomes.

S/He oversees the operational use of Epics Referral module and serves as a systems and support analyst expert in the utilization of the Referral and Patient Work Queues. Included in this position is oversight of the Epic Managed Care Analyst team, who are responsible for the key structural build that crosses all parts of the EMR system.

This position is serves as a liaison between Managed Care Coordinators, OHSU Managed Care Contracting Office, the ITG EPIC Team, outside referring providers and 3rd Party Insurers.

This Program Manager will be responsible for working closely with leadership staff in the build and support of Managed Care work queues to ensure efficient and patient focused processes are implemented.

Centralized Managed Care Leadership:

• Works closely with the Centralized Managed Care Leadership team to develop standard referral and patient work queue builds.
• Responsible for overseeing Epic referral and patient work queue projects and maintenance.
• Works closely with all OHSU billing entities to develop better understanding on how front-end staff can enhance the entire revenue cycle.
• Looks for operational efficiencies in collection of necessary Managed Care components in a way that enhances the patient experience. Assists with establishing protocols and work queue flow to produce desired outcomes.
• Represents Centralized Managed Care at key Patient Access meetings including Managed Care Contracting Status Updates, New Business Assessment Team and the UMG Integration Meeting
• Responsible for overseeing and assisting the Managed Care Analyst team.
  Supports Epic go live projects with OHSU partners

Managed Care Coordination:

• Coordinates with Third Party payors to gain access to their websites for eligibility and benefit verification for all front end access/Managed Care employees.
• Independently facilitates a monthly meeting for all Managed Care Coordinators (MCC) to offer continuing education and support. Creates agenda, organizes payor presentations and deliveries educational materials.
• Provides instruction and guidance to practice staff for processes related to managed care
• Serves as a liaison between the MCC group, Managed Care Contracting and 3rd Party Insurers. This position is responsible for training information from Contracting and 3rd Party Insurers in a reliable and understandable manner to the MCCs across OHSU.
• Serves as a liaison between the MCC group, Contracting, University Medical Group (UMG) and Patient Business Services (PBS) to help create a seamless process for Managed Care.

OPEx:

• Participates in Ambulatory OPEx projects, specifically those related to Centralized and Non-Centralized Managed Care initiatives
• Presents educational sessions related to best practice and process improvements related to Managed Care

Epic Referral & Auth/Cert Workflows:

• Works directly with ITG on all workflows that utilize the Epic Referral (including Auth/Cert) module/application
• Monitors and develops workflows that use the Epic Referral and Patient Work Queue modules/applications
• Recommends changes necessary in order to maintain an efficient revenue cycle.

Personnel Management:

• Directly supervise Managed Care Analyst Support team. Interviewing, hiring, orientation, work assignment, counseling, disciplinary procedures, up to and including dismissal. Monitors workflows and establishes standards.
• Quality Evaluates workflows and develops methodology for ensuring all direct reports are producing quality work.
• Efficiency Evaluates and if necessary develops workflows that ensure that direct reports are maximizing their output and support.
• Productivity monitoring Establishes processes for setting daily/weekly/monthly goals for each direct report that can be used for accountability measures.
  

• Education: High school diploma plus one of the following Bachelors degree in healthcare administrator or related degree or 4 additional years of experience.
• Experience: At least five years experience in a complex, multifaceted healthcare setting; experience should include exposure to ambulatory, in-patient, and surgery workflows related to revenue cycle, financial analysis and project management.
• Job Related Knowledge, Skills and Abilities: Superb oral and written communication skills, complex decision making analysis and an ability to develop concise communications. S/he must be familiar with Microsoft Excel and Visio. S/he must have superb organizational skills and strong customer service orientation and experience. Must have 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. A working knowledge of OHSU system, policies, procedures and the OHSUMG practices is a must.
• Must be able to perform the essential functions of the position with or without accommodation

• Education: Masters Degree in Healthcare Administration or related.
• Experience: Specific experience with and integrated health record, Epic preferred. Epic certification in either Cadence, Prelude, ADT or Resolute applications.
• Job Related Knowledge, Skills and Abilities: A working knowledge of OHSU systems, policies and procedures.
• Registrations, Certifications and/or Licenses: Epic Certification in Revenue Cycle application (Cadence, Prelude, ADT, or Resolute)

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